Provider Demographics
NPI:1649442484
Name:RIZZO, BROOKS MARLOW (APRN/ FNP)
Entity type:Individual
Prefix:
First Name:BROOKS
Middle Name:MARLOW
Last Name:RIZZO
Suffix:
Gender:F
Credentials:APRN/ FNP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:BROOKS
Other - Last Name:RIZZO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CFNP
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:RULEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38771-0369
Mailing Address - Country:US
Mailing Address - Phone:662-756-4024
Mailing Address - Fax:
Practice Address - Street 1:840A N. OAK AVE.
Practice Address - Street 2:
Practice Address - City:RULEVILLE
Practice Address - State:MS
Practice Address - Zip Code:38771
Practice Address - Country:US
Practice Address - Phone:662-756-4024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR863771363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00458310Medicaid
MS2008004013OtherANCC CERTIFICATION #
MSMR1887530OtherDRUG ENFORCEMENT ADMINISTRATION (DEA)
MSMR1887530OtherDRUG ENFORCEMENT ADMINISTRATION (DEA)