Provider Demographics
NPI:1124897491
Name:PUTNAM, BROOKE MICHELLE (RN, BSN)
Entity type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:MICHELLE
Last Name:PUTNAM
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9775 BOBWHITE WAY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-2718
Mailing Address - Country:US
Mailing Address - Phone:850-384-3359
Mailing Address - Fax:
Practice Address - Street 1:2912 N E ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-1324
Practice Address - Country:US
Practice Address - Phone:850-432-1596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9463405163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse