Provider Demographics
NPI:1528574092
Name:ROOK, MELANIE (ARNP)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:ROOK
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 1:1994 E SUNRISE BLVD # 118
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-1462
Mailing Address - Country:US
Mailing Address - Phone:954-701-9104
Mailing Address - Fax:954-944-0778
Practice Address - Street 1:1451 NE 4TH AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-1033
Practice Address - Country:US
Practice Address - Phone:954-627-9118
Practice Address - Fax:954-627-9822
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9293120363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9293120OtherFLORIDA LICENSE