Provider Demographics
NPI:1598870222
Name:BROOKS, ELIZABETH KAY (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:KAY
Last Name:BROOKS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13090 N 94TH DR STE 204
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4258
Mailing Address - Country:US
Mailing Address - Phone:623-972-3335
Mailing Address - Fax:623-972-2453
Practice Address - Street 1:13090 N 94TH DR STE 204
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4258
Practice Address - Country:US
Practice Address - Phone:623-972-3335
Practice Address - Fax:623-972-2453
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2008-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN058707363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZRN058707OtherLICENSE
AZRN058707OtherLICENSE
AZZ109381Medicare PIN