Provider Demographics
NPI:1063523413
Name:BROCKLEY, PATRICIA MARY (NP RN)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MARY
Last Name:BROCKLEY
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Gender:F
Credentials:NP RN
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Mailing Address - Street 1:6090 REDWOOD BLVD G
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-4569
Mailing Address - Country:US
Mailing Address - Phone:415-798-3106
Mailing Address - Fax:415-798-3180
Practice Address - Street 1:361 3RD ST STE E
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901
Practice Address - Country:US
Practice Address - Phone:415-499-4030
Practice Address - Fax:415-507-2634
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-09-28
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Provider Licenses
StateLicense IDTaxonomies
CA368074163WW0101X
CA8387363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory