Provider Demographics
NPI:1043672827
Name:RUPERT, BROOKE ALECIA (ARNP)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ALECIA
Last Name:RUPERT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5950 S FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2532
Mailing Address - Country:US
Mailing Address - Phone:863-688-3550
Mailing Address - Fax:863-687-8969
Practice Address - Street 1:4710 N. HABANA AVENUE
Practice Address - Street 2:SUITE #307
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7151
Practice Address - Country:US
Practice Address - Phone:813-874-2000
Practice Address - Fax:813-875-9303
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9339338163W00000X
FLARNP9339338363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse