Provider Demographics
NPI:1396319935
Name:BROOKS, ERIN GRACE (APRN)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:GRACE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:GRACE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:512 GRANT AVE APT A
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-2983
Mailing Address - Country:US
Mailing Address - Phone:321-243-5181
Mailing Address - Fax:
Practice Address - Street 1:2400 N COURTENAY PKWY STE 100
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4127
Practice Address - Country:US
Practice Address - Phone:321-985-9097
Practice Address - Fax:321-301-4869
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11012686363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily