Provider Demographics
NPI:1912944950
Name:BROGAN, PATRICIA ANN (ADVANCE PRACTICE NUR)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANN
Last Name:BROGAN
Suffix:
Gender:F
Credentials:ADVANCE PRACTICE NUR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1043 ROUTE 70
Mailing Address - Street 2:UNIT C3
Mailing Address - City:MANCHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:08759-5806
Mailing Address - Country:US
Mailing Address - Phone:732-657-6100
Mailing Address - Fax:
Practice Address - Street 1:1043 ROUTE 70
Practice Address - Street 2:UNIT C3
Practice Address - City:MANCHESTER
Practice Address - State:NJ
Practice Address - Zip Code:08759-5806
Practice Address - Country:US
Practice Address - Phone:732-657-6100
Practice Address - Fax:732-657-0111
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NC09345000364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ042631UCEOtherMEDICARE
NJ0640701Medicaid
NJ0640701Medicaid