Provider Demographics
NPI:1811579071
Name:CASAZZA, BROOKE (NP)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:CASAZZA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:
Other - Last Name:HUMPHREYS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1703 AVENUE 4 NW
Mailing Address - Street 2:
Mailing Address - City:ATKINS
Mailing Address - State:AR
Mailing Address - Zip Code:72823-3224
Mailing Address - Country:US
Mailing Address - Phone:479-886-0076
Mailing Address - Fax:
Practice Address - Street 1:1751 E GARRY AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-5814
Practice Address - Country:US
Practice Address - Phone:479-886-0766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR212735363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health