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General NPI Number Information
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NPI Number | 1780967364
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Entity Type | Individual
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Provider Name | TRENT MICHAEL BROADUS ARNP
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Gender | Male
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Dates
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Enumeration Date | 09/21/2011
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1695 N SUNRISE WAY
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City | PALM SPRINGS
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State | CA
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Zip | 92262-3701
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Country | US
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Telephone | 760-323-2118
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Fax | 760-416-1651
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Provider Business Mailing Address
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Address Line | 1695 NORTH SUNRISE WAY
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City | PALM SPRINGS
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State | CA
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Zip | 92262-3701
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Country | US
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Telephone | 760-323-2118
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Fax | 760-416-1651
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | ARNP9353539
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 570228
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95006008
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License Number State | CA
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