Provider Demographics
NPI:1871713073
Name:BROUSSARD, JULIETTE R (MSN, RN, FNPC)
Entity type:Individual
Prefix:MRS
First Name:JULIETTE
Middle Name:R
Last Name:BROUSSARD
Suffix:
Gender:F
Credentials:MSN, RN, FNPC
Other - Prefix:
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Mailing Address - Street 1:PO BOX 7096
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77726
Mailing Address - Country:US
Mailing Address - Phone:409-833-0342
Mailing Address - Fax:877-770-4091
Practice Address - Street 1:810 HOSPITAL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4600
Practice Address - Country:US
Practice Address - Phone:409-833-0342
Practice Address - Fax:409-242-6038
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX651610363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX29790YTTL5Medicare PIN