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Contact Information

JACQUELINE L AGENBROAD, NP
1300 N 12TH ST
SUITE 407
PHOENIX, AZ85006-2848
 Phone: 602-239-6762
 Fax: 602-239-5112
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Nurse Practitioner

363L00000X 50 Nurse Practitioner
Indicates primary specialty

NPI Profile & details for JACQUELINE L AGENBROAD · (Female)

NPI # 1447222328
Status Active
Credentials NP (Nurse Practitioner)
Entity Individual
Enumeration date 02/03/2006
Last updated 06/12/2008 - About 18 years ago
Sole proprietor 1 No
Identifiers
  • AZ License # NP290
  • AZ License # RN097748
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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