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General NPI Number Information
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NPI Number | 1750531711
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Entity Type | Individual
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Provider Name | MICHELLE L BROADBENT NP
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Gender | Female
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Dates
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Enumeration Date | 09/26/2008
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Last Update Date | 10/19/2017
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Provider Practice Location Address
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Address Line | 603 HAIFLEIGH ST
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City | FRANKLIN
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State | LA
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Zip | 70538-3734
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Country | US
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Telephone | 337-828-9092
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Fax |
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Provider Business Mailing Address
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Address Line | 380 W PALMETTO PARK RD UNIT 408C
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City | BOCA RATON
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State | FL
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Zip | 33432-6719
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Country | US
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Telephone | 601-669-1038
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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 | 08068
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 9468755
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R855964
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License Number State | MS
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