Healthcare Provider Details

I. General information

NPI: 1366226755
Provider Name (Legal Business Name): CYNTHIA MCBROOM MSN,AGACNP,FNP, ENP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CINDY MCBROOM NP

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13677 W MCDOWELL RD
GOODYEAR AZ
85395-2600
US

IV. Provider business mailing address

PO BOX 64
WADDELL AZ
85355-0064
US

V. Phone/Fax

Practice location:
  • Phone: 623-882-1500
  • Fax:
Mailing address:
  • Phone: 602-882-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number296909
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number296909
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: