Healthcare Provider Details

I. General information

NPI: 1902202641
Provider Name (Legal Business Name): TONYA M BROUGHTON APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2014
Last Update Date: 07/10/2020
Certification Date: 07/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1454 MARKET ST
CHARLESTOWN IN
47111-1839
US

IV. Provider business mailing address

1454 MARKET ST
CHARLESTOWN IN
47111-1839
US

V. Phone/Fax

Practice location:
  • Phone: 812-503-5071
  • Fax: 812-503-5076
Mailing address:
  • Phone: 812-503-5071
  • Fax: 812-503-5076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71005212A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: