Healthcare Provider Details

I. General information

NPI: 1194692780
Provider Name (Legal Business Name): BROOKE ANN HUFF AG-ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2025
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 HARRISON BLVD
OGDEN UT
84403-3195
US

IV. Provider business mailing address

380 E 650 S
KAYSVILLE UT
84037-2523
US

V. Phone/Fax

Practice location:
  • Phone: 801-387-2000
  • Fax:
Mailing address:
  • Phone: 801-387-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number9806309-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: