Provider Demographics
NPI:1750989760
Name:GRIGGS, BROOKE JOSEPHINE (MPAS, PA-C)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:JOSEPHINE
Last Name:GRIGGS
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 N OCEAN DR APT 2A
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33404-2889
Mailing Address - Country:US
Mailing Address - Phone:407-733-8405
Mailing Address - Fax:
Practice Address - Street 1:3920 N OCEAN DR APT 2A
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404-2889
Practice Address - Country:US
Practice Address - Phone:407-733-8405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9113713363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant