MEDICARE: ANN V BROCK P.A.

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	363AS0400X	Surgical Physician Assistant	PA9102723	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	:	1689640732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN V BROCK P.A.

Provider Business Mailing Address
First Line	:	PO BOX 2147
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33902-2147
Country	:	US
Telephone Number	:	239-343-1105
Fax Number	:	239-343-1106

Provider Business Practice Location Address
First Line	:	13340 METRO PKWY STE 400
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33966-4818
Country	:	US
Telephone Number	:	239-343-1105
Fax Number	:	239-343-1106

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

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	03/24/2021

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Directions to “ ANN V BROCK P.A.” Practice Location

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