Healthcare Provider Details

I. General information

NPI: 1669718201
Provider Name (Legal Business Name): BROOKE SUZETTE HUMPHREY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/01/2013
Last Update Date: 07/10/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6816 W 8TH CIRCLE
ARVADA CO
80003-1139
US

IV. Provider business mailing address

6816 W 85TH CIR, UNIT 36
ARVADA CO
80003-1139
US

V. Phone/Fax

Practice location:
  • Phone: 720-500-5488
  • Fax:
Mailing address:
  • Phone: 720-500-5488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0990515
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: