MEDICARE: MS. TA'VIANNA MONIQUE BROOKS

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	133V00000X	Registered Dietitian	86445385	FL

General Provider Information

NPI Number	:	1174477665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TA'VIANNA MONIQUE BROOKS

Provider Business Mailing Address
First Line	:	10885 KRUGERRAND LN
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-7319
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3601 KERNAN BLVD S FL 32224
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-9602
Country	:	US
Telephone Number	:	904-234-2302
Fax Number	:

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

Provider Enumeration Date	:	02/23/2026
Last Update Date	:	02/23/2026

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