Provider Demographics
NPI:1952805152
Name:ROTATORI, BROOKE L (MD)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:L
Last Name:ROTATORI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 W FAIRBANKS AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4777
Mailing Address - Country:US
Mailing Address - Phone:407-635-5543
Mailing Address - Fax:321-842-4002
Practice Address - Street 1:1111 W FAIRBANKS AVE STE 220
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4777
Practice Address - Country:US
Practice Address - Phone:407-635-5543
Practice Address - Fax:321-842-4002
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME146765207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110426200Medicaid