MEDICARE: MISS BROOKE HOLWAY ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	APRN9267665	FL

General Provider Information

NPI Number	:	1518108307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS BROOKE HOLWAY ARNP

Provider Business Mailing Address
First Line	:	3300 S FISKE BLVD
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-4306
Country	:	US
Telephone Number	:	904-273-6533
Fax Number	:	904-273-6532

Provider Business Practice Location Address
First Line	:	1102 A1A N STE 104
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-4098
Country	:	US
Telephone Number	:	904-273-6533
Fax Number	:	904-273-6532

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2009
Last Update Date	:	09/27/2021

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