Healthcare Provider Details

I. General information

NPI: 1497238257
Provider Name (Legal Business Name): TIFFANY BROCE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 X ST STE 3010
SACRAMENTO CA
95817-2229
US

IV. Provider business mailing address

4501 X ST STE 3010
SACRAMENTO CA
95817-2229
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-5907
  • Fax: 916-703-5267
Mailing address:
  • Phone: 916-734-5907
  • Fax: 916-703-5267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number812956
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95022283
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: