Provider Demographics
NPI:1346322492
Name:FIT4DUTY LLC
Entity Type:Organization
Organization Name:FIT4DUTY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:P
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, NP-C
Authorized Official - Phone:812-285-1943
Mailing Address - Street 1:1446 GATEWAY PLZ
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-4206
Mailing Address - Country:US
Mailing Address - Phone:812-285-1943
Mailing Address - Fax:812-285-1963
Practice Address - Street 1:1446 GATEWAY PLZ
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-4206
Practice Address - Country:US
Practice Address - Phone:812-285-1943
Practice Address - Fax:812-285-1963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001986B261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN47173PMedicare UPIN