Healthcare Provider Details

I. General information

NPI: 1992478754
Provider Name (Legal Business Name): BREANNE ELIZABETH HADDOCK PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2021
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14416 W MEEKER BLVD BLDG C BUILDING C
SUN CITY WEST AZ
85375-5284
US

IV. Provider business mailing address

14416 W MEEKER BLVD BLDG C
SUN CITY WEST AZ
85375-5284
US

V. Phone/Fax

Practice location:
  • Phone: 623-876-3800
  • Fax:
Mailing address:
  • Phone: 623-876-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: