Provider Demographics
NPI:1083787675
Name:THERMIDOR, BROOKE A (DO)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:A
Last Name:THERMIDOR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:A
Other - Last Name:MORRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1020 LAKE SUMTER LNDG
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-2699
Mailing Address - Country:US
Mailing Address - Phone:352-674-8905
Mailing Address - Fax:352-674-8901
Practice Address - Street 1:779 KRISTINE WAY
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32163-0099
Practice Address - Country:US
Practice Address - Phone:844-884-9355
Practice Address - Fax:352-674-6030
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS12680207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIE407YMedicare PIN
PA1021934910001Medicaid