Provider Demographics
NPI:1699742817
Name:BRASFIELD, JODIE (ACNP)
Entity type:Individual
Prefix:
First Name:JODIE
Middle Name:
Last Name:BRASFIELD
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6750 E BAYWOOD AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-1749
Mailing Address - Country:US
Mailing Address - Phone:480-835-6100
Mailing Address - Fax:
Practice Address - Street 1:6750 E BAYWOOD AVE STE 301
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1749
Practice Address - Country:US
Practice Address - Phone:480-835-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2168363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care