Healthcare Provider Details

I. General information

NPI: 1225701584
Provider Name (Legal Business Name): BROOKE BENDER APRN.CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

689 E ALTAMONTE DR
ALTAMONTE SPRINGS FL
32701-4801
US

IV. Provider business mailing address

4160 LITTLE YORK RD STE 20
DAYTON OH
45414-5803
US

V. Phone/Fax

Practice location:
  • Phone: 407-767-7262
  • Fax: 407-775-5002
Mailing address:
  • Phone: 937-454-9527
  • Fax: 937-454-9532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1048533
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN.CNP.0031389
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN.CNP.0000079
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN11036325
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: