Healthcare Provider Details

I. General information

NPI: 1528798451
Provider Name (Legal Business Name): TOMIKA BROWN LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11361 N 99TH AVE STE 400&402
PEORIA AZ
85345-5470
US

IV. Provider business mailing address

2701 N 16TH ST STE 316
PHOENIX AZ
85006-1266
US

V. Phone/Fax

Practice location:
  • Phone: 602-650-1212
  • Fax: 623-972-6173
Mailing address:
  • Phone: 602-650-1212
  • Fax: 623-972-6173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLP042878
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: