MEDICARE: BROOKE HIGGINS D.O.M

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	171100000X	Acupuncturist	AP2936	FL

General Provider Information

NPI Number	:	1598007502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE HIGGINS D.O.M

Provider Business Mailing Address
First Line	:	3732 AVALON PARK EAST BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-4805
Country	:	US
Telephone Number	:	407-452-9755
Fax Number	:

Provider Business Practice Location Address
First Line	:	3730 AVALON PARK EAST BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-4805
Country	:	US
Telephone Number	:	407-452-9755
Fax Number	:

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

Provider Enumeration Date	:	03/18/2013
Last Update Date	:	03/18/2013

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