Healthcare Provider Details

I. General information

NPI: 1255299541
Provider Name (Legal Business Name): STACY ANN BROOKS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2026
Last Update Date: 01/14/2026
Certification Date: 01/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 N 19TH AVE STE 425
PHOENIX AZ
85015-2481
US

IV. Provider business mailing address

5501 N 19TH AVE STE 425
PHOENIX AZ
85015-2481
US

V. Phone/Fax

Practice location:
  • Phone: 602-492-9880
  • Fax:
Mailing address:
  • Phone: 602-492-9880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number333437
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: