Provider Demographics
NPI:1821044140
Name:AREHART, PENNYE BROSCHE (ARNP)
Entity type:Individual
Prefix:MRS
First Name:PENNYE
Middle Name:BROSCHE
Last Name:AREHART
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:PO BOX 600368
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32260-0368
Mailing Address - Country:US
Mailing Address - Phone:904-287-4186
Mailing Address - Fax:
Practice Address - Street 1:12303 SAN JOSE BLVD
Practice Address - Street 2:CARESPOT
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-2640
Practice Address - Country:US
Practice Address - Phone:904-306-7386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1941382363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP 1941382OtherFLORIDA NURSING LICENSE
S92129Medicare ID - Type Unspecified