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NPI Code Detail

MEDICARE: SARA JEAN DEBROCK APRN, FNP-C

MEDICARE: SARA JEAN DEBROCK APRN, FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner209.020343IL

General Provider Information

NPI Number : 1043816218
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARA JEAN DEBROCK APRN, FNP-C
Provider Business Mailing Address
First Line : 2019 E GATE PKWY
Second Line :
City : ROCKFORD
State : IL
Zip : 61108-5967
Country : US
Telephone Number : 630-450-0488
Fax Number :
Provider Business Practice Location Address
First Line : 321 ARNOLD AVE
Second Line :
City : ROCKFORD
State : IL
Zip : 61108-2315
Country : US
Telephone Number : 630-450-0488
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/11/2020
Last Update Date : 10/06/2021

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