Individual
LATRICIA BROADDUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5833 RICHMOND TAPPAHANNOCK HWY STE 106B, AYLETT, VA 23009-3007
(042) 230-0298
Mailing address
PO BOX 13, SAINT STEPHENS CHURCH, VA 23148-0013
(804) 664-2271
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
0024181570
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0732762767
—
VA
Enumeration date
10/31/2018
Last updated
03/06/2024
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