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General NPI Number Information
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NPI Number | 1477438422
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Entity Type | Individual
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Provider Name | BROOKE LAUREN STEVENS COTA/L
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Gender | Female
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Dates
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Enumeration Date | 08/08/2025
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Last Update Date | 08/08/2025
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Provider Practice Location Address
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Address Line | 2669 ENTERPRISE RD
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City | ORANGE CITY
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State | FL
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Zip | 32763-8217
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Country | US
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Telephone | 321-972-8326
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Fax |
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Provider Business Mailing Address
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Address Line | 5103 TAYLOR AVE
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City | PORT ORANGE
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State | FL
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Zip | 32127-5425
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Country | US
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Telephone | 386-285-4143
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 20076
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License Number State | FL
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