Provider Demographics
NPI:1982704441
Name:BROOKER, NANCY IRENE (MSN, APRN, ANP-BC)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:IRENE
Last Name:BROOKER
Suffix:
Gender:F
Credentials:MSN, APRN, ANP-BC
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:IRENE
Other - Last Name:BROOKER-MUIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:3033 N CENTRAL AVE STE 145
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2808
Mailing Address - Country:US
Mailing Address - Phone:480-964-2273
Mailing Address - Fax:623-974-6721
Practice Address - Street 1:9610 N METRO PKWY W
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-1402
Practice Address - Country:US
Practice Address - Phone:480-964-2273
Practice Address - Fax:602-843-1560
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2194363LA2200X, 363LA2200X
COAPN.0004902-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ210657Medicaid