Provider Demographics
NPI:1427483239
Name:LARSEN, BROOKE LEE (NP-C)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:LEE
Last Name:LARSEN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 N TORTOISE ROCK DR UNIT 22
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780-3174
Mailing Address - Country:US
Mailing Address - Phone:435-673-5373
Mailing Address - Fax:
Practice Address - Street 1:1490 E FOREMASTER DR STE 150
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4495
Practice Address - Country:US
Practice Address - Phone:435-673-5373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2025-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT365893-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO325355YWU7Medicare PIN