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General NPI Number Information
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NPI Number | 1710971221
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Entity Type | Individual
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Provider Name | CYNTHIA DENISE BROADNAX MSN, CRNP
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Gender | Female
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Dates
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Enumeration Date | 09/12/2005
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Last Update Date | 12/12/2023
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Provider Practice Location Address
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Address Line | 6660 SECURITY BLVD
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City | WOODLAWN
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State | MD
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Zip | 21207-4012
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Country | US
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Telephone | 443-380-0552
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 22389 PMB 82739
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City | NASHVILLE
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State | TN
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Zip | 37202-2389
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Country | US
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Telephone | 866-315-2626
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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 | R125951
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License Number State | MD
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