Colleen Ruth Broderick, NP

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

RN000099282 Issued in AZ

Practice address

711 S 14TH Ave
Ste B
Safford, AZ 85546-3337

Phone

(480) 318-5584

NPI assigned

Apr 22, 2006

Last updated

Nov 23, 2012By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1353628800000",
    "number": "1801852447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8453 S NAVAJO DR",
            "city": "SAFFORD",
            "state": "AZ",
            "postal_code": "855467753",
            "telephone_number": "928-792-7842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 S 14TH AVE",
            "address_2": "STE B",
            "city": "SAFFORD",
            "state": "AZ",
            "postal_code": "855463337",
            "telephone_number": "480-318-5584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRODERICK",
        "first_name": "COLLEEN",
        "middle_name": "RUTH",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-04-22",
        "last_updated": "2012-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "AZ",
            "license": "RN000099282",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Gerontology Nurse Practitioner in Safford, AZ
• Providers in Safford, AZ by specialty
• Gerontology Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.