Healthcare Provider Details

I. General information

NPI: 1174118905
Provider Name (Legal Business Name): S. RENEE BROYLES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2021
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 N TIMBER HOLLOW DR APT 1513
FAIRFIELD OH
45014-7737
US

IV. Provider business mailing address

15 N TIMBER HOLLOW DR APT 1513
FAIRFIELD OH
45014-7737
US

V. Phone/Fax

Practice location:
  • Phone: 513-338-9852
  • Fax:
Mailing address:
  • Phone: 513-338-9852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0027978
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: