MEDICARE: JUSTIN ROSS HOOPER 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	363L00000X	Nurse Practitioner	ARNP9314595	FL
2	363LA2100X	Acute Care Nurse Practitioner	ARNP9314595	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	:	1255833513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN ROSS HOOPER ARNP

Provider Business Mailing Address
First Line	:	1285 VISTA HILLS DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-5642
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1285 VISTA HILLS DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-5642
Country	:	US
Telephone Number	:	863-698-2089
Fax Number	:

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

Provider Enumeration Date	:	03/02/2018
Last Update Date	:	04/15/2020

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