MRS. JACQUELINE LEA AGENBROAD (NPI# 1447222328) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447222328 |
| Entity Type | Individual |
| Full Name | MRS. JACQUELINE LEA AGENBROAD |
| Credential | NP |
| Practice Address |
1300 N 12th St Suite 407 Phoenix AZ 85006-2848 |
| Mailing Address |
12895 W Pasadena Ave Litchfield Park AZ 85340 |
| Practice Telephone | 6022396762 |
| Practice Fax Number | 6022395112 |
| Mailing Telephone | 6239352373 |
| Mailing Fax Number | 6239324558 |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2008-06-12 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | NP290 | AZ | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363L00000X | Nurse Practitioner | RN097748 | AZ | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1300 N 12TH ST SUITE 407 |
| City | PHOENIX |
| State | AZ |
| Zip Code | 85006-2848 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831192590 | William Walter Holland | Family Medicine | 1300 N 12th St, Suite 605, Phoenix, AZ 85006-2848 | 2005-05-24 |
| 1699235127 | Mary Mihalko | Student in an Organized Health Care Education/Training Program | 1300 N 12th St, Phoenix, AZ 85006-2848 | 2019-03-21 |
| 1447779608 | Sara Marie Sorace | Physician Assistant | 1300 N 12th St, Phoenix, AZ 85006-2848 | 2017-09-19 |
| 1104350990 | Hillary Tamar | Student in an Organized Health Care Education/Training Program | 1300 N 12th St, Suite 605, Phoenix, AZ 85006-2848 | 2017-04-18 |
| 1669906459 | Michelle Sommer | Family Medicine | 1300 N 12th St, Suite 605, Phoenix, AZ 85006-2848 | 2017-04-18 |
| 1922532712 | Herbert Rosenbaum | Student in an Organized Health Care Education/Training Program | 1300 N 12th St, Suite 605, Phoenix, AZ 85006-2848 | 2017-04-18 |
| 1992239909 | Karalyne Blochberger | Family Medicine | 1300 N 12th St, Suite 605, Phoenix, AZ 85006-2848 | 2017-04-17 |
| 1104350123 | Akua Ekunwe | Family Medicine | 1300 N 12th St, Suite 605, Phoenix, AZ 85006-2848 | 2017-04-17 |
| 1073047098 | Viktoria Krajnc | Family Medicine | 1300 N 12th St, Suite 605, Phoenix, AZ 85006-2848 | 2017-04-17 |
| 1568995876 | Stefanie Handrick Brichta | Student in an Organized Health Care Education/Training Program | 1300 N 12th St, Suite 320, Phoenix, AZ 85006-2848 | 2017-04-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356949929 | Teresa Louise Cox | Pharmacist | 1800 E Van Buren St., St. Luke's Behavioral Health, Phoenix, AZ 85006 | 2020-10-15 |
| 1558985036 | Amanda Stanford | Nurse Practitioner | 925 E Mc Dowell Rd, Phoenix, AZ 85006 | 2020-06-01 |
| 1023638582 | Supraja Prakash | Genetic Counselor, MS | 1920 E Cambridge Ave., Rosenberg Bldg., Suite 304, Phoenix, AZ 85006 | 2020-04-24 |
| 1760017099 | Phoenix Medical Psychiatric Hospital, LLC | Psychiatric Hospital | 1346 Mcdowell Road, Phoenix, AZ 85006 | 2020-03-06 |
| 1265093108 | Zulianna Ibrahim | Student in an Organized Health Care Education/Training Program | Banner University Medical Center Phoenix Family Medicin, 1300 N. 12th Street Suite 605, Phoenix, AZ 85006 | 2019-06-21 |
| 1306318340 | Leah Margaret Hillier | Family Medicine | 1300 N 12th St - Suite 500, Phoenix, AZ 85006 | 2018-12-31 |
| 1477032357 | Joann Moskop | Chiropractor | 2719 N Greenfield Rd., Phoenix, AZ 85006 | 2018-08-10 |
| 1619464468 | Ana Maria Lara | Naturopath | 926 E Mcdowell Rd Ste 204, Phoenix, AZ 85006 | 2018-04-17 |
| 1194221770 | Nisha Bharat Patel | Student in an Organized Health Care Education/Training Program | Edwards Medical Plaza Suite 320, 1300 North 12th Street, Phoenix, AZ 85006 | 2018-04-03 |
| 1710486352 | Julia Cyr | Registered Nurse | 1008 E Mcdowell Rd Unit A, Phoenix, AZ 85006 | 2018-02-09 |
| Find all providers in zip 85006 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992322168 | Tessie Leigh Eberhart | Nurse Practitioner | 6025 N 27th Ave Ste 6, Phoenix, AZ 85017-1764 | 2020-07-02 |
| 1952927048 | John Leo Conway Jr. | Nurse Practitioner | 1705 E Claremont St, Phoenix, AZ 85016-1514 | 2020-06-24 |
| 1902434855 | Alyssa Young | Nurse Practitioner | 3033 N 34th Pl, Phoenix, AZ 85018-6903 | 2020-03-27 |
| 1609408194 | Az Regenerative Medicne | Nurse Practitioner | 16620 N 40th St Ste G2, Phoenix, AZ 85032-3351 | 2020-02-12 |
| 1124667175 | Jennifer Leigh Hanisch | Nurse Practitioner | 7314 S 26th Ln, Phoenix, AZ 85041-6475 | 2019-12-21 |
| 1295370179 | Jessica Anne Harper | Nurse Practitioner | 4141 N 32nd St Ste 104, Phoenix, AZ 85018-4775 | 2019-11-14 |
| 1134764590 | Rachael Bennett | Nurse Practitioner | 14001 N 7th St Ste F111, Phoenix, AZ 85022-4382 | 2019-11-08 |
| 1720621410 | Cynthia Chebator | Nurse Practitioner | 3233 W Peoria Ave Ste 106&120, Phoenix, AZ 85029-4614 | 2019-10-24 |
| 1295396273 | Ashleigh Beatty | Nurse Practitioner | 334 E Acapulco Ln, Phoenix, AZ 85022-3620 | 2019-06-21 |
| 1295292589 | Rosalind Robles Caumban | Nurse Practitioner | 4575 E Cactus Rd Ste 130, Phoenix, AZ 85032-7700 | 2019-02-23 |
| Find all providers in PHOENIX | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.