Provider Demographics
NPI:1568992055
Name:BRAZZALE, ARIEL PATRICIA (FNP- BC)
Entity Type:Individual
Prefix:
First Name:ARIEL
Middle Name:PATRICIA
Last Name:BRAZZALE
Suffix:
Gender:F
Credentials:FNP- BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4936 PHEASANT CT
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-3384
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9430 WICKER AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOHN
Practice Address - State:IN
Practice Address - Zip Code:46373-9400
Practice Address - Country:US
Practice Address - Phone:219-669-1034
Practice Address - Fax:877-822-9116
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2022-11-18
Deactivation Date:2022-10-24
Deactivation Code:
Reactivation Date:2022-11-15
Provider Licenses
StateLicense IDTaxonomies
IN142462246ZC0007X
IN71013263A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant