Provider Demographics
NPI:1497067565
Name:BROSKEY, BECKY AMREN (NP)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:AMREN
Last Name:BROSKEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 E SHEA BLVD
Mailing Address - Street 2:SUITE 175
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3074
Mailing Address - Country:US
Mailing Address - Phone:866-662-4560
Mailing Address - Fax:877-561-7566
Practice Address - Street 1:4545 E SHEA BLVD
Practice Address - Street 2:SUITE 175
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3074
Practice Address - Country:US
Practice Address - Phone:866-662-4560
Practice Address - Fax:877-561-7566
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PARN517981L364SF0001X
PASP010545363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health