Basic Information
| Provider Information | |||||||||
| NPI: | 1730392382 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROOKS | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | FITE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MPH, RD, LDN, CSR | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FITE | ||||||||
| OtherFirstName: | REBECCA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | RD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 500 MOONLIGHT CT | ||||||||
| Address2: | |||||||||
| City: | SAINT CLOUD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347719062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8133137779 | ||||||||
| FaxNumber: | 8889741047 | ||||||||
| Practice Location | |||||||||
| Address1: | 1154 CELEBRATION BLVD | ||||||||
| Address2: | |||||||||
| City: | KISSIMMEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347474605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4075661780 | ||||||||
| FaxNumber: | 4075661756 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2007 | ||||||||
| LastUpdateDate: | 07/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 07/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133VN1005X | ND 5113 | FL | Y | Dietary & Nutritional Service Providers | Dietitian, Registered | Nutrition, Renal |
No ID Information.