Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP9993 | AZ |
NPI | 1003347147 |
---|---|
Provider Name | Tyler Ann Brockhoff |
First Address | Phoenix, AZ 85032-6201 |
Second Address | Phoenix, AZ 85016-8220 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2017 |
Last Update Date | 21/03/2017 |