Individual
MS. BRENDA TRUELUCK BROADNAX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MEDICAID PROVIDER
Contact information
Practice address
1421 SW 27TH AVE, #2701, OCALA, FL 34471-2042
(352) 861-1590
(351) 861-1590
Mailing address
1421 SW 27TH AVE, #2701, OCALA, FL 34471-2042
(352) 861-1590
(351) 861-1590
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
01/07/2008
Last updated
01/07/2008
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