Basic Information
| Provider Information | |||||||||
| NPI: | 1578194171 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STARR | ||||||||
| FirstName: | BROOKE | ||||||||
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| Credential: | AGACNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4125 SUNDANCE PLACE LOOP | ||||||||
| Address2: | |||||||||
| City: | MULBERRY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338600179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8638387671 | ||||||||
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| Practice Location | |||||||||
| Address1: | 26606 MAGNOLIA BLVD | ||||||||
| Address2: | |||||||||
| City: | LUTZ | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335598545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139070123 | ||||||||
| FaxNumber: | 8139075559 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2020 | ||||||||
| LastUpdateDate: | 02/01/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | 11005907 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.