Individual
MR. TIJAY BROADNAX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
APD PROVIDER
Contact information
Practice address
1514 S ALEXANDER ST STE 202, PLANT CITY, FL 33563-8418
(813) 652-8119
Mailing address
1514 S ALEXANDER ST STE 202, PLANT CITY, FL 33563-8418
(813) 652-8119
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
FL
Other
Enumeration date
07/18/2022
Last updated
07/18/2022
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