Healthcare Provider Details

I. General information

NPI: 1487255063
Provider Name (Legal Business Name): BROOKE SWONGER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BROOKE HOLTZEN NP

II. Dates (important events)

Enumeration Date: 11/02/2020
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 E GRANT RD
TUCSON AZ
85712-2805
US

IV. Provider business mailing address

5301 E GRANT RD
TUCSON AZ
85712-2805
US

V. Phone/Fax

Practice location:
  • Phone: 520-324-2308
  • Fax: 520-324-1406
Mailing address:
  • Phone: 520-324-2308
  • Fax: 520-324-1406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN189404
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number257399
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number257399
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: