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General NPI Number Information
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NPI Number | 1679455778
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Entity Type | Individual
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Provider Name | SCARLETTE RENEE BROADWAY FNP
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Gender | Female
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Dates
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Enumeration Date | 07/22/2025
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 623 W 15TH ST
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City | WASHINGTON
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State | NC
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Zip | 27889-3526
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Country | US
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Telephone | 252-644-6450
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Fax | 252-644-6451
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Provider Business Mailing Address
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Address Line | PO BOX 306599
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City | NASHVILLE
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State | TN
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Zip | 37230-6599
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Country | US
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Telephone | 252-644-6450
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5022658
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License Number State | NC
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