Healthcare Provider Details

I. General information

NPI: 1477144681
Provider Name (Legal Business Name): DAVID MICHAEL BROWN AGACNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2021
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 S CRISMON RD
MESA AZ
85209-3767
US

IV. Provider business mailing address

1301 S CRISMON RD
MESA AZ
85209-3767
US

V. Phone/Fax

Practice location:
  • Phone: 480-358-6100
  • Fax:
Mailing address:
  • Phone: 480-358-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number246706
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: