Individual
DR. JULIANNE M WYSOCKI BROADWATER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
303 N CLYDE MORRIS BLVD, DAYTONA BEACH, FL 32114-2709
(386) 425-2285
(386) 425-7522
Mailing address
303 N CLYDE MORRIS BLVD, DAYTONA BEACH, FL 32114-2709
(386) 226-4590
(386) 226-4577
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
OS16421
FL
207R00000X
Internal Medicine Physician
OS16421
FL
208M00000X
Hospitalist Physician
OS16421
FL
Other
Enumeration date
06/16/2009
Last updated
09/29/2021
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