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General NPI Number Information
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NPI Number | 1083078653
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Entity Type | Individual
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Provider Name | JANE BROSSOIT
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Gender | Female
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Dates
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Enumeration Date | 04/11/2016
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Last Update Date | 04/11/2016
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Provider Practice Location Address
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Address Line | 233 STUARTSBURG RD
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City | BUENA VISTA
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State | VA
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Zip | 24416-4604
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Country | US
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Telephone | 540-261-5330
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Fax |
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Provider Business Mailing Address
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Address Line | 8026 LITTLEDOE CT
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City | PORT RICHEY
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State | FL
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Zip | 34668-2318
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Country | US
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Telephone | 727-452-6663
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | PN5172735
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License Number State | FL
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