1285053645 NPI number — MRS. RHONDA BROUGHTON ARNP, FNP-C

Table of content: MRS. RHONDA BROUGHTON ARNP, FNP-C (NPI 1285053645)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285053645 NPI number — MRS. RHONDA BROUGHTON ARNP, FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROUGHTON
Provider First Name:
RHONDA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP, FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SINGLEY
Provider Other First Name:
RHONDA
Provider Other Middle Name:
DEES
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285053645
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1270 BLUE HERON LN N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32250-8505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-246-8436
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
580 W 8TH ST
Provider Second Line Business Practice Location Address:
TOWER 1, 5TH FLOOR, STE 513
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32209-6533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-633-0797
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/14/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  ARNP3187952 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 003152232A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 012796700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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