Provider Demographics
NPI:1225364227
Name:BROWN, NICHOLE T (NP-C)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:T
Last Name:BROWN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20325 N 51ST AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-4622
Mailing Address - Country:US
Mailing Address - Phone:623-466-6350
Mailing Address - Fax:602-358-8698
Practice Address - Street 1:20325 N 51ST AVE STE 160
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-4622
Practice Address - Country:US
Practice Address - Phone:623-466-6350
Practice Address - Fax:602-358-8698
Is Sole Proprietor?:No
Enumeration Date:2009-10-26
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3477363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily