Healthcare Provider Details

I. General information

NPI: 1417844234
Provider Name (Legal Business Name): JAMIE MUIRBROOK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9936 E REVOLUTION DR
MESA AZ
85212-8951
US

IV. Provider business mailing address

9936 E REVOLUTION DR
MESA AZ
85212-8951
US

V. Phone/Fax

Practice location:
  • Phone: 801-635-8707
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10819758-4405
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number332070
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: