Agenbroad, Jacqueline Lea

Agenbroad, Jacqueline Lea is an individual health care provider with primary practice located at 1300 N 12Th St Suite 407, Phoenix AZ 85006-2848. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as her primary health care specialty. Agenbroad, Jacqueline Lea can be contacted via phone (602) 239-6762.

Contact Information

Primary practice address
1300 N 12Th St Suite 407 Phoenix AZ 85006-2848
Phone: (602) 239-6762
Fax: (602) 239-5112
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X RN097748 Arizona
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X NP290 Arizona

Profile Details

NPI number 1447222328
LBN Legal business name Agenbroad, Jacqueline Lea
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 3rd, 2006
Last updated Jun 12th, 2008 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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