Provider Demographics
NPI:1316483357
Name:PITTMAN, BROOKES K (ARNP)
Entity type:Individual
Prefix:
First Name:BROOKES
Middle Name:K
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4372 SOUTHSIDE BLVD
Mailing Address - Street 2:UNIT 206
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-8501
Mailing Address - Country:US
Mailing Address - Phone:904-642-7774
Mailing Address - Fax:
Practice Address - Street 1:4372 SOUTHSIDE BLVD
Practice Address - Street 2:UNIT 206
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-8501
Practice Address - Country:US
Practice Address - Phone:904-642-7774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-15
Last Update Date:2017-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9250651363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily