Healthcare Provider Details

I. General information

NPI: 1780240374
Provider Name (Legal Business Name): LINSEY BETH BROADBENT DNP, FNP-BC, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2019
Last Update Date: 05/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1283 DEER VALLEY DR
PARK CITY UT
84060-5182
US

IV. Provider business mailing address

PO BOX 187
OAKLEY UT
84055-0187
US

V. Phone/Fax

Practice location:
  • Phone: 435-640-6136
  • Fax:
Mailing address:
  • Phone: 435-640-6136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3104015-8900
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3104015-4405
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number3104015-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: