Basic Information
| Provider Information | |||||||||
| NPI: | 1144825266 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BISHIR | ||||||||
| FirstName: | BROOKE | ||||||||
| MiddleName: | |||||||||
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| Credential: | RN, CCRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 449 W 23RD ST | ||||||||
| Address2: | |||||||||
| City: | PANAMA CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 324054507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8507698341 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 449 W 23RD ST | ||||||||
| Address2: | |||||||||
| City: | PANAMA CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 324054507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8507698341 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2020 | ||||||||
| LastUpdateDate: | 12/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN9542397 | FL | Y | Nursing Service Providers | Registered Nurse |
No ID Information.