Healthcare Provider Details

I. General information

NPI: 1619487394
Provider Name (Legal Business Name): BRITTANY ANN MACKIE P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2017
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1688 E BOSTON ST STE 121-124
GILBERT AZ
85295-6221
US

IV. Provider business mailing address

1688 E BOSTON ST STE 101
GILBERT AZ
85295-6222
US

V. Phone/Fax

Practice location:
  • Phone: 480-855-0085
  • Fax: 480-855-0086
Mailing address:
  • Phone: 480-855-0085
  • Fax: 480-855-0086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number55003
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: