MEDICARE: JENNIFER S BROYLES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME131695	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235259011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER S BROYLES MD

Provider Business Mailing Address
First Line	:	790 DUNLAWTON AVE STE E
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-4222
Country	:	US
Telephone Number	:	386-760-1877
Fax Number	:	386-760-2791

Provider Business Practice Location Address
First Line	:	790 DUNLAWTON AVE STE E
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-4222
Country	:	US
Telephone Number	:	386-760-1877
Fax Number	:	386-760-2791

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	07/16/2025

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Directions to “ JENNIFER S BROYLES MD” Practice Location

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