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General NPI Number Information
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NPI Number | 1174580682
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Entity Type | Individual
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Provider Name | TONIA BROUSSEAU DO
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Gender | Female
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Dates
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Enumeration Date | 04/27/2006
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 820 PRUDENTIAL DR STE 713 EMERGENCY RESOURCES GROUP
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8209
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Country | US
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Telephone | 904-396-5682
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Fax | 904-346-0864
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Provider Business Mailing Address
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Address Line | PO BOX 863640
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City | ORLANDO
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State | FL
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Zip | 32886-3640
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Country | US
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Telephone | 904-396-5682
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Fax | 904-346-0864
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | OS9193
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2080P0204X
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Taxonomy Name | Pediatric Emergency Medicine (Pediatrics) Physician
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License Number | OS9193
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License Number State | FL
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