Individual
BEVERLY BROADNAX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2814 EDWARDS AVE S, SAINT PETERSBURG, FL 33705-3653
(727) 642-6894
Mailing address
2814 EDWARDS AVE S, SAINT PETERSBURG, FL 33705-3653
(727) 642-6894
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN142291
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
141557300
—
FL
Enumeration date
07/08/2014
Last updated
07/08/2014
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