Provider Demographics
NPI:1386241479
Name:HOMAN, BROOKE LINDSAY (PA-C)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:LINDSAY
Last Name:HOMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2508 MYRTLE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-2700
Mailing Address - Country:US
Mailing Address - Phone:833-246-7662
Mailing Address - Fax:
Practice Address - Street 1:2508 MYRTLE ST STE 100
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-2700
Practice Address - Country:US
Practice Address - Phone:833-246-7662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-02
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA061865363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
14998206OtherCAQH