Provider Demographics
NPI:1386943546
Name:BROCCHINI, JANNA BERNICE (FNP)
Entity type:Individual
Prefix:MRS
First Name:JANNA
Middle Name:BERNICE
Last Name:BROCCHINI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27011 S AUSTIN RD
Mailing Address - Street 2:
Mailing Address - City:RIPON
Mailing Address - State:CA
Mailing Address - Zip Code:95366-9625
Mailing Address - Country:US
Mailing Address - Phone:209-599-3860
Mailing Address - Fax:209-599-9662
Practice Address - Street 1:1262 E NORTH ST
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-4962
Practice Address - Country:US
Practice Address - Phone:209-599-3860
Practice Address - Fax:209-599-9662
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-26
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA751355163W00000X
CA20754363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse