Provider Demographics
NPI:1417352360
Name:BENJAMIN, BROOKE AUDREY (ARNP)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:AUDREY
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:AUDREY
Other - Last Name:GROCHOWSKI/SILVERN/YALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:645 E MISSOURI AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1351
Mailing Address - Country:US
Mailing Address - Phone:602-262-8917
Mailing Address - Fax:602-262-8890
Practice Address - Street 1:645 E MISSOURI AVE
Practice Address - Street 2:STE 300
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1351
Practice Address - Country:US
Practice Address - Phone:602-262-8900
Practice Address - Fax:602-262-8890
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7321363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ172302Medicare PIN