Provider Demographics
NPI:1750712550
Name:BROCK, JOY (RNP)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:BROCK
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 E WALNUT ST
Mailing Address - Street 2:5TH FLOOR- CLINICAL CONSULTING & IMPLEMENTATION
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91188-0001
Mailing Address - Country:US
Mailing Address - Phone:626-405-6931
Mailing Address - Fax:
Practice Address - Street 1:393 E WALNUT ST
Practice Address - Street 2:5TH FLOOR- CLINICAL CONSULTING & IMPLEMENTATION
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91188-0001
Practice Address - Country:US
Practice Address - Phone:626-405-6931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN398582 NP12375363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily