Provider Demographics
NPI:1619631587
Name:GAMBINO, BROOKE ELISE (NP)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ELISE
Last Name:GAMBINO
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 1:628 E CALAVAR RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-4741
Mailing Address - Country:US
Mailing Address - Phone:480-636-9362
Mailing Address - Fax:
Practice Address - Street 1:6316 W UNION HILLS DR STE 210
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1001
Practice Address - Country:US
Practice Address - Phone:480-342-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2022-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN193224163WC0200X
AZ273250363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine