MEDICARE: BROOKES K PITTMAN 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	363LF0000X	Family Nurse Practitioner	ARNP9250651	FL

General Provider Information

NPI Number	:	1316483357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKES K PITTMAN ARNP

Provider Business Mailing Address
First Line	:	4372 SOUTHSIDE BLVD
Second Line	:	UNIT 206
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-8501
Country	:	US
Telephone Number	:	904-642-7774
Fax Number	:

Provider Business Practice Location Address
First Line	:	4372 SOUTHSIDE BLVD
Second Line	:	UNIT 206
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-8501
Country	:	US
Telephone Number	:	904-642-7774
Fax Number	:

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

Provider Enumeration Date	:	01/15/2017
Last Update Date	:	01/15/2017

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Directions to “ BROOKES K PITTMAN ARNP” Practice Location

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