Provider Demographics
NPI:1871225409
Name:BROCK, ASHLEY NICHOLE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:NICHOLE
Last Name:BROCK
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:NICHOLE
Other - Last Name:MACDONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:10028 W GROSS AVE
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-1202
Mailing Address - Country:US
Mailing Address - Phone:623-261-8966
Mailing Address - Fax:
Practice Address - Street 1:13733 N PRASADA PKWY STE 100
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85388-8014
Practice Address - Country:US
Practice Address - Phone:623-444-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-30
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2022012410363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty