Brooke Revell Sansom, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

11015583 Issued in FL

Practice address

19611 FL-20 West
Blountstown, FL 32424

Phone

(850) 674-5645

NPI assigned

Oct 11, 2019

Last updated

Nov 12, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Florida Department of Health

  dba Liberty County Health Department

  • Public Health or Welfare Agency
  • Bristol, FL
  • NPI 1548263114
  Medicare reassignment NPD
• Florida Department of Health

  dba Calhoun County Health Department

  • Public Health or Welfare Agency
  • Blountstown, FL
  • NPI 1932149531
  Medicare reassignment NPD
• Florida Department of Health

  dba Levy County Health Department

  • Public Health or Welfare Agency
  • Bronson, FL
  • NPI 1154395390
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1570752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636675200000",
    "number": "1932741840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19611 FL-20 WEST",
            "city": "BLOUNTSTOWN",
            "state": "FL",
            "postal_code": "32424",
            "telephone_number": "850-674-5645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19611 FL-20 WEST",
            "city": "BLOUNTSTOWN",
            "state": "FL",
            "postal_code": "32424",
            "telephone_number": "850-674-5645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANSOM",
        "first_name": "BROOKE",
        "middle_name": "REVELL",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-11",
        "last_updated": "2021-11-12",
        "certification_date": "2021-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11015583",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "FL",
            "license": "9435556",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rivertown Assisted Living LLC
• Rivertown Transitional Care LLC
• Sarah Roper
• Ropers Personal Home Care
• Maegan D. Russell
• Sarah a Roper (Rivertown Senior Care)
• Keven Mickel Schock, M.A.
• Myron Daniel Schrock, D.M.D.
• Jennifer Michele Scott, PA-C
• Senior Dental Care

• Family Nurse Practitioner in Blountstown, FL
• Providers in Blountstown, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.