Healthcare Provider Details

I. General information

NPI: 1063936219
Provider Name (Legal Business Name): SARA BRENZA FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2017
Last Update Date: 11/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W THOMAS RD STE 300
PHOENIX AZ
85013-4220
US

IV. Provider business mailing address

500 W THOMAS RD STE 500
PHOENIX AZ
85013-4220
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-8000
  • Fax: 602-406-3111
Mailing address:
  • Phone: 602-406-4000
  • Fax: 602-406-6498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.015031
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP9680
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: