Basic Information
Provider Information
NPI: 1578705224
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BROOKS
FirstName: DANNY
MiddleName: ARTHUR
NamePrefix:  
NameSuffix:  
Credential: ARNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4881 NW 8TH AVE
Address2: SUITE 2
City: GAINESVILLE
State: FL
PostalCode: 326054582
CountryCode: US
TelephoneNumber: 3523736338
FaxNumber: 3523736144
Practice Location
Address1: 1315 NW 21ST AVE
Address2: SUITE 1
City: CHIEFLAND
State: FL
PostalCode: 326261977
CountryCode: US
TelephoneNumber: 3524905100
FaxNumber: 3524905103
Other Information
ProviderEnumerationDate: 03/26/2009
LastUpdateDate: 12/09/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XARNP2831322FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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