Provider Demographics
NPI:1902693393
Name:BROOKS, HEATHER MARIE (ACNPC-AG)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:BROOKS
Suffix:
Gender:
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20195 E RAVEN DR
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-3464
Mailing Address - Country:US
Mailing Address - Phone:602-295-4265
Mailing Address - Fax:
Practice Address - Street 1:20195 E RAVEN DR
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-3464
Practice Address - Country:US
Practice Address - Phone:602-295-4265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ322524363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty