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General NPI Number Information
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NPI Number | 1356055875
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Entity Type | Individual
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Provider Name | JAMI AMANDA VAN BROCKLIN APRN, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 01/10/2023
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 4585 E SPEEDWAY BLVD BLDG B
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City | TUCSON
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State | AZ
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Zip | 85712-5309
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Country | US
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Telephone | 203-274-5055
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Fax | 520-202-1733
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Provider Business Mailing Address
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Address Line | 4585 E SPEEDWAY BLVD BLDG 2
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City | TUCSON
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State | AZ
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Zip | 85712-5309
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Country | US
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Telephone | 520-327-4505
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Fax | 520-202-1733
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 295409
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License Number State | AZ
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