Provider Demographics
NPI:1356055875
Name:VAN BROCKLIN, JAMI AMANDA (APRN, PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:JAMI
Middle Name:AMANDA
Last Name:VAN BROCKLIN
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
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Mailing Address - Street 1:4585 E SPEEDWAY BLVD BLDG 2
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-5309
Mailing Address - Country:US
Mailing Address - Phone:520-327-4505
Mailing Address - Fax:520-202-1733
Practice Address - Street 1:4585 E SPEEDWAY BLVD BLDG B
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-5309
Practice Address - Country:US
Practice Address - Phone:203-274-5055
Practice Address - Fax:520-202-1733
Is Sole Proprietor?:No
Enumeration Date:2023-01-10
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ295409363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health