MEDICARE: MS. CYNTHIA DENISE BROADNAX MSN, CRNP

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	363LF0000X	Family Nurse Practitioner	R125951	MD

General Provider Information

NPI Number	:	1710971221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CYNTHIA DENISE BROADNAX MSN, CRNP

Provider Business Mailing Address
First Line	:	PO BOX 22389
Second Line	:	PMB 82739
City	:	NASHVILLE
State	:	TN
Zip	:	37202-2389
Country	:	US
Telephone Number	:	866-315-2626
Fax Number	:

Provider Business Practice Location Address
First Line	:	6660 SECURITY BLVD
Second Line	:
City	:	WOODLAWN
State	:	MD
Zip	:	21207-4012
Country	:	US
Telephone Number	:	443-380-0552
Fax Number	:

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

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	12/12/2023

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