Provider Demographics
NPI:1710534359
Name:BROSAMER, ERIN NICOLE (PA-C, CAQ-PSYCH)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:NICOLE
Last Name:BROSAMER
Suffix:
Gender:F
Credentials:PA-C, CAQ-PSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:19782 MACARTHUR BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2417
Mailing Address - Country:US
Mailing Address - Phone:714-545-5550
Mailing Address - Fax:949-991-2040
Practice Address - Street 1:1310 W STEWART DR STE 306
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3838
Practice Address - Country:US
Practice Address - Phone:714-545-5550
Practice Address - Fax:949-991-2040
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA57436364SP0808X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical