Provider Demographics
NPI:1134894165
Name:GOEGAN, BREANNE FRANCINE (PAC)
Entity type:Individual
Prefix:MRS
First Name:BREANNE
Middle Name:FRANCINE
Last Name:GOEGAN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MISS
Other - First Name:BREANNE
Other - Middle Name:
Other - Last Name:ARNOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:875 S DOBSON RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5710
Mailing Address - Country:US
Mailing Address - Phone:310-738-7072
Mailing Address - Fax:480-899-2994
Practice Address - Street 1:875 S DOBSON RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5710
Practice Address - Country:US
Practice Address - Phone:480-899-9800
Practice Address - Fax:480-899-2994
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-11
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
AZ8653363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant