Provider Demographics
NPI:1225701584
Name:BENDER, BROOKE (APRNCNP)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:BENDER
Suffix:
Gender:F
Credentials:APRNCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4160 LITTLE YORK RD STE 20
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-5803
Mailing Address - Country:US
Mailing Address - Phone:937-454-9527
Mailing Address - Fax:937-454-9532
Practice Address - Street 1:689 E ALTAMONTE DR
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4801
Practice Address - Country:US
Practice Address - Phone:407-767-7262
Practice Address - Fax:407-775-5002
Is Sole Proprietor?:No
Enumeration Date:2021-07-30
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1048533363LA2100X
OHAPRN.CNP.0031389363LA2100X
OHAPRN.CNP.0000079363LA2100X
FLAPRN11036325363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care