Healthcare Provider Details

I. General information

NPI: 1457904104
Provider Name (Legal Business Name): BRIANNE ANTOINETTE YINGLING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRIANNE ANTOINETTE YINGLING

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date: 10/10/2019
Reactivation Date: 10/18/2019

III. Provider practice location address

2601 N 3RD ST STE 212
PHOENIX AZ
85004-1145
US

IV. Provider business mailing address

3104 E CAMELBACK RD
PHOENIX AZ
85016-4502
US

V. Phone/Fax

Practice location:
  • Phone: 602-492-2263
  • Fax: 585-206-4898
Mailing address:
  • Phone: 602-492-2263
  • Fax: 585-206-4898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number229685
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: