- Practice location
- 1300 N 12TH St, Suite 407, Phoenix, AZ 85006-2848
- Phone
- 602-239-6762
- Fax
- 602-239-5112
- Last updated
- June 12, 2008
Jacqueline Lea Agenbroad is a Nurse Practitioner based in Phoenix, AZ. Jacqueline Lea Agenbroad practices in Phoenix, AZ and has the professional credentials of NP. The NPI Number for Jacqueline Lea Agenbroad is 1447222328 and holds a License No. RN097748 (AZ). The current practice location address for Jacqueline Lea Agenbroad is 1300 N 12TH St, Suite 407, Phoenix, AZ 85006-2848 and can be reached out via phone at 602-239-6762 and via fax at 602-239-5112.
Provider Profile Details
- NPI Number
- 1447222328
- Provider Name
- Jacqueline Lea Agenbroad
- Credential
- NP
- Provider Entity Type
- Individual
- Gender
- Female
- Address
- 1300 N 12TH St, Suite 407, Phoenix, AZ 85006-2848
- Phone Number
- 602-239-6762
- Fax Number
- 602-239-5112
- Primary Taxonomy
- Nurse Practitioner · 363L00000X
- Sole Proprietor
- No
- Provider Enumeration Date
- February 3, 2006
- Last Update Date
- June 12, 2008
- NPI Status
- Active
Provider Business Practice Location Address Details
- Address
- 1300 N 12TH St
Suite 407
Phoenix, AZ 85006-2848 - City
- Phoenix
- State
- Arizona
- Zip
- 85006-2848
- Phone Number
- 602-239-6762
- Fax Number
- 602-239-5112
Provider Business Mailing Address Details
- Address
- 12895 W Pasadena Ave
Litchfield Park, AZ 85340 - City
- Litchfield Park
- State
- AZ
- Zip
- 85340
- Phone Number
- 623-935-2373
- Fax Number
- 623-932-4558
License Information
- License Number (1)
- RN097748
- License State (1)
- AZ
- Taxonomy (1)
- Nurse Practitioner · 363L00000X
- License Number (2)
- NP290
- License State (2)
- AZ
- Taxonomy (2)
- Nurse Practitioner · 363L00000X · Primary
Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| No legacy identifiers (Medicaid, Medicare or plan IDs) are on file for this provider. | |||
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Frequently Asked Questions
What is the NPI number of Mrs. Jacqueline L Agenbroad, NP?
The NPI number of Mrs. Jacqueline L Agenbroad, NP is 1447222328. It was assigned on February 3, 2006 and is currently active in the NPPES registry.
What is the specialty of Mrs. Jacqueline L Agenbroad, NP?
Mrs. Jacqueline L Agenbroad, NP is registered under the primary taxonomy Nurse Practitioner (code 363L00000X), licensed in AZ under license number RN097748.
Where does Mrs. Jacqueline L Agenbroad, NP practice?
The practice location is 1300 N 12TH St, Suite 407, Phoenix, AZ 85006-2848. The office can be reached at 602-239-6762 (phone) or 602-239-5112 (fax).
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). It is used in HIPAA standard transactions.
How do I verify this NPI record?
This record is sourced from the public NPPES NPI Registry maintained by CMS. You can confirm it by searching NPI 1447222328 directly on the NPPES registry website.