Provider Demographics
NPI:1891091716
Name:BROCKWELL, ALICE RODRIGUEZ (ARNP-BC)
Entity Type:Individual
Prefix:MS
First Name:ALICE
Middle Name:RODRIGUEZ
Last Name:BROCKWELL
Suffix:
Gender:F
Credentials:ARNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 SE 7TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-3117
Mailing Address - Country:US
Mailing Address - Phone:954-290-4344
Mailing Address - Fax:
Practice Address - Street 1:620 SE 7TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-3117
Practice Address - Country:US
Practice Address - Phone:954-290-4344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2009752363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily