Provider Demographics
NPI:1124769617
Name:BROOKS, SHAQUANA SUZAN
Entity type:Individual
Prefix:
First Name:SHAQUANA
Middle Name:SUZAN
Last Name:BROOKS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 DYLAN LOREN CIR STE 102
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-4437
Mailing Address - Country:US
Mailing Address - Phone:407-277-8665
Mailing Address - Fax:
Practice Address - Street 1:10800 DYLAN LOREN CIR STE 102
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-4437
Practice Address - Country:US
Practice Address - Phone:407-277-8665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-06
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11019064163WG0100X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163WG0100XNursing Service ProvidersRegistered NurseGastroenterology