Provider Demographics
NPI:1114741345
Name:LAVINE, BROOKE MORGAN
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:MORGAN
Last Name:LAVINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19643 RUGGED TRUNK TRL
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-2143
Mailing Address - Country:US
Mailing Address - Phone:561-797-8760
Mailing Address - Fax:
Practice Address - Street 1:500 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33403-3598
Practice Address - Country:US
Practice Address - Phone:407-898-2767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11035581363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics