MEDICARE: BROOKE WEISS 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	ARNP9214999	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932696788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE WEISS ARNP

Provider Business Mailing Address
First Line	:	4040 49TH ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33709-5734
Country	:	US
Telephone Number	:	727-526-9135
Fax Number	:	727-526-4346

Provider Business Practice Location Address
First Line	:	4586 E MICHIGAN ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32812-5233
Country	:	US
Telephone Number	:	407-751-2297
Fax Number	:

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

Provider Enumeration Date	:	04/17/2018
Last Update Date	:	04/18/2018

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