Healthcare Provider Details

I. General information

NPI: 1386943546
Provider Name (Legal Business Name): JANNA BERNICE BROCCHINI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2011
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1262 E NORTH ST
MANTECA CA
95336-4962
US

IV. Provider business mailing address

27011 S AUSTIN RD
RIPON CA
95366-9625
US

V. Phone/Fax

Practice location:
  • Phone: 209-599-3860
  • Fax: 209-599-9662
Mailing address:
  • Phone: 209-599-3860
  • Fax: 209-599-9662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number751355
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20754
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: