Provider Demographics
NPI:1598019697
Name:BROQUEZA, JOVEL (DNP)
Entity type:Individual
Prefix:DR
First Name:JOVEL
Middle Name:
Last Name:BROQUEZA
Suffix:
Gender:
Credentials:DNP
Other - Prefix:
Other - First Name:JOVEL
Other - Middle Name:
Other - Last Name:VILORIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 699
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-0699
Mailing Address - Country:US
Mailing Address - Phone:360-903-1829
Mailing Address - Fax:360-254-1908
Practice Address - Street 1:201 NE PARK PLAZA DR STE 200
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5871
Practice Address - Country:US
Practice Address - Phone:360-903-1829
Practice Address - Fax:360-991-0337
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-29
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277000517363LF0000X, 363LP0808X
OR10029352363LP0808X
WAAP61586857363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAP61586857OtherWASHINGTON STATE BOARD OF NURSING
OR10029352OtherOREGON STATE BOARD OF NURSING