1821044140 NPI number — MRS. PENNYE BROSCHE AREHART ARNP

Table of content: MRS. PENNYE BROSCHE AREHART ARNP (NPI 1821044140)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821044140 NPI number — MRS. PENNYE BROSCHE AREHART ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AREHART
Provider First Name:
PENNYE
Provider Middle Name:
BROSCHE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821044140
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 600368
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32260-0368
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-287-4186
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12303 SAN JOSE BLVD
Provider Second Line Business Practice Location Address:
CARESPOT
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32223-2640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-306-7386
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/26/2006

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: 363L00000X , with the licence number:  ARNP1941382 , 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)

  • Identifier: ARNP 1941382 . This is a "FLORIDA NURSING LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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