Provider Demographics
NPI:1801414883
Name:BRAVERMAN, SCOTT (FNP-C)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:BRAVERMAN
Suffix:
Gender:M
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 1:2177 S MCQUEEN RD APT 2041
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-1841
Mailing Address - Country:US
Mailing Address - Phone:602-670-0124
Mailing Address - Fax:
Practice Address - Street 1:225 E GERMANN RD STE 140
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-2906
Practice Address - Country:US
Practice Address - Phone:602-999-0203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ242002363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily