MEDICARE: REBECCA FITE BROOKS MPH, RD, LDN, CSR

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	133VN1005X	Renal Nutrition Registered Dietitian	ND 5113	FL

General Provider Information

NPI Number	:	1730392382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA FITE BROOKS MPH, RD, LDN, CSR

Provider Business Mailing Address
First Line	:	500 MOONLIGHT CT
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34771-9062
Country	:	US
Telephone Number	:	813-313-7779
Fax Number	:	888-974-1047

Provider Business Practice Location Address
First Line	:	1154 CELEBRATION BLVD
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34747-4605
Country	:	US
Telephone Number	:	407-566-1780
Fax Number	:	407-566-1756

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

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	11/27/2023

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