Individual
AMY E. BROKKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
410 W 10TH AVE, COLUMBUS, OH 43210-1240
(614) 293-8305
(614) 293-3124
Mailing address
700 ACKERMAN RD, SUITE 570, COLUMBUS, OH 43202-1559
(614) 293-2046
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50003150
OH
363A00000X
Physician Assistant
PA10004767
WA
363A00000X
Physician Assistant
PA9104538
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001600000
—
FL
05
—
7922404
—
WA
05
—
PENDING
—
OH
Enumeration date
01/10/2006
Last updated
06/26/2015
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