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NPI Code Detail

MEDICARE: BRITT MARIE BROADWAY FNP

MEDICARE:   BRITT MARIE BROADWAY  FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner30365SC

General Provider Information

NPI Number : 1205627437
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRITT MARIE BROADWAY FNP
Provider Business Mailing Address
First Line : 7613 GARNERS FERRY RD
Second Line :
City : COLUMBIA
State : SC
Zip : 29209-3811
Country : US
Telephone Number : 803-427-7199
Fax Number :
Provider Business Practice Location Address
First Line : 7613 GARNERS FERRY RD
Second Line :
City : COLUMBIA
State : SC
Zip : 29209-3811
Country : US
Telephone Number : 839-600-9190
Fax Number : 839-600-9195
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2025
Last Update Date : 07/21/2025

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Directions to “ BRITT MARIE BROADWAY FNP” Practice Location

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