MEDICARE: BROOKE ALECIA RUPERT 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	163W00000X	Registered Nurse	RN9339338	FL
2	363LP0200X	Pediatric Nurse Practitioner	ARNP9339338	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	:	1043672827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE ALECIA RUPERT ARNP

Provider Business Mailing Address
First Line	:	5950 S FLORIDA AVE
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-2532
Country	:	US
Telephone Number	:	863-688-3550
Fax Number	:	863-687-8969

Provider Business Practice Location Address
First Line	:	4710 N. HABANA AVENUE
Second Line	:	SUITE #307
City	:	TAMPA
State	:	FL
Zip	:	33614-7151
Country	:	US
Telephone Number	:	813-874-2000
Fax Number	:	813-875-9303

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

Provider Enumeration Date	:	03/22/2016
Last Update Date	:	02/20/2017

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