Healthcare Provider Details

I. General information

NPI: 1639967490
Provider Name (Legal Business Name): MICHAEL ERIC BROWN JR. ACNPC-AG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2025
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 N CENTRAL AVE STE 2
PHOENIX AZ
85020-2463
US

IV. Provider business mailing address

9200 N CENTRAL AVE STE 2
PHOENIX AZ
85020-2463
US

V. Phone/Fax

Practice location:
  • Phone: 480-999-4954
  • Fax: 480-999-4712
Mailing address:
  • Phone: 480-999-4954
  • Fax: 480-999-4712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number323282
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRN209649
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: