Healthcare Provider Details

I. General information

NPI: 1730392382
Provider Name (Legal Business Name): REBECCA FITE BROOKS MPH, RD, LDN, CSR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REBECCA FITE RD

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 11/27/2023
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1154 CELEBRATION BLVD
KISSIMMEE FL
34747-4605
US

IV. Provider business mailing address

500 MOONLIGHT CT
SAINT CLOUD FL
34771-9062
US

V. Phone/Fax

Practice location:
  • Phone: 407-566-1780
  • Fax: 407-566-1756
Mailing address:
  • Phone: 813-313-7779
  • Fax: 888-974-1047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License NumberND 5113
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: