Healthcare Provider Details

I. General information

NPI: 1801889894
Provider Name (Legal Business Name): VAUGHN ANTHONY BROZEK JR. FNP-C, DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 03/07/2023
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 N CARRIER PKWY
GRAND PRAIRIE TX
75050-5484
US

IV. Provider business mailing address

6245 RUFE SNOW DR STE 280-134
WATAUGA TX
76148-3349
US

V. Phone/Fax

Practice location:
  • Phone: 214-518-6319
  • Fax: 214-518-6396
Mailing address:
  • Phone: 817-576-4828
  • Fax: 817-730-9096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC6838
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP129778
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAP129778
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: