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General NPI Number Information
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NPI Number | 1417319450
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Entity Type | Individual
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Provider Name | CARMEN D BROUSSARD FNP-C
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Gender | Female
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Dates
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Enumeration Date | 03/28/2016
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Last Update Date | 03/28/2016
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Provider Practice Location Address
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Address Line | 602 LAWRENCE ST SUITE E
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City | TOMBALL
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State | TX
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Zip | 77375-6499
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Country | US
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Telephone | 832-534-7880
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Fax | 713-852-2316
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Provider Business Mailing Address
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Address Line | 602 LAWRENCE ST SUITE E
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City | TOMBALL
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State | TX
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Zip | 77375-6499
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Country | US
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Telephone | 832-534-7880
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Fax | 713-852-2316
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 644043
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License Number State | TX
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