Doctor Name: | MRS. ANDREA RAE BROCKMAN |
NPI Number: | 1043519929 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MMS, PA-C |
License Number: | PA9105703 |
Business Practice Address: | 13005 State Road 80 Loxahatchee, FL - 334709206 |
Business Phone Number: | 5617982002 |
Business Fax Number: | |
Mailing Address: | 13005 State Road 80, LOXAHATCHEE |
State: | FL |
Postal Code: | 334709206 |
Phone Number: | 5617982002 |
Fax Number: | |
NPI Enumeration Date: | 03/18/2011 |
NPI Last Update Date: | 03/18/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | PA9105703 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |