MEDICARE: MS. ALICE RODRIGUEZ BROCKWELL ARNP-BC

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	363LF0000X	Family Nurse Practitioner	ARNP 2009752	FL

General Provider Information

NPI Number	:	1891091716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALICE RODRIGUEZ BROCKWELL ARNP-BC

Provider Business Mailing Address
First Line	:	620 SE 7TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-3117
Country	:	US
Telephone Number	:	954-290-4344
Fax Number	:

Provider Business Practice Location Address
First Line	:	620 SE 7TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-3117
Country	:	US
Telephone Number	:	954-290-4344
Fax Number	:

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

Provider Enumeration Date	:	02/10/2011
Last Update Date	:	03/10/2011

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