1730392382 NPI number — REBECCA FITE BROOKS MPH, RD, LDN, CSR

Table of content: REBECCA FITE BROOKS MPH, RD, LDN, CSR (NPI 1730392382)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730392382 NPI number — REBECCA FITE BROOKS MPH, RD, LDN, CSR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROOKS
Provider First Name:
REBECCA
Provider Middle Name:
FITE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MPH, RD, LDN, CSR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FITE
Provider Other First Name:
REBECCA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1730392382
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 MOONLIGHT CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT CLOUD
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34771-9062
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-313-7779
Provider Business Mailing Address Fax Number:
888-974-1047

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1154 CELEBRATION BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KISSIMMEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34747-4605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-566-1780
Provider Business Practice Location Address Fax Number:
407-566-1756
Provider Enumeration Date:
05/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133VN1005X , with the licence number:  ND 5113 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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