MEDICARE: BRENDA CORRIPIO 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	363LA2200X	Adult Health Nurse Practitioner	2739412	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	:	1205988730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA CORRIPIO ARNP

Provider Business Mailing Address
First Line	:	591 SW ROMORA BAY
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34986-3423
Country	:	US
Telephone Number	:	772-879-2105
Fax Number	:

Provider Business Practice Location Address
First Line	:	3607 15TH AVE
Second Line	:	SUITE A
City	:	VERO BEACH
State	:	FL
Zip	:	32960-6513
Country	:	US
Telephone Number	:	772-562-8522
Fax Number	:

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

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	07/08/2007

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