Provider Demographics
NPI:1053075820
Name:BROCKMAN, JAMIE (PAC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:BROCKMAN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14674 W MOUNTAIN VIEW BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-2708
Mailing Address - Country:US
Mailing Address - Phone:623-544-6860
Mailing Address - Fax:623-544-6861
Practice Address - Street 1:14674 W MOUNTAIN VIEW BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2708
Practice Address - Country:US
Practice Address - Phone:623-544-6860
Practice Address - Fax:623-544-6861
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical