Healthcare Provider Details

I. General information

NPI: 1124642764
Provider Name (Legal Business Name): BROOKE ELIZABETH HOTOP FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2020
Last Update Date: 05/29/2020
Certification Date: 05/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 HOSPITAL LN STE 101
PERRYVILLE MO
63775-4204
US

IV. Provider business mailing address

212 HOSPITAL LN STE 101
PERRYVILLE MO
63775-4204
US

V. Phone/Fax

Practice location:
  • Phone: 573-547-7888
  • Fax:
Mailing address:
  • Phone: 573-547-7888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2020009265
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: