Gina Leisha Broussard, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

565760 Issued in CA

Practice address

3349 G St Ste F
Merced, CA 95340-0978

Phone

(209) 349-8459

Fax

(209) 580-4671

NPI assigned

Aug 31, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Timothy S. Johnston, M.D. PC

  • Family Medicine Physician
  • Merced, CA
  • NPI 1407306665
  Medicare reassignment NPD
• Timothy S. Johnston, M.D. PC

  dba Sunshine Pediatrics

  • Primary Care Clinic/Center
  • Merced, CA
  • NPI 1427793371
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1472601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723161600000",
    "number": "1023564812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1154 GRANITE CT",
            "city": "MERCED",
            "state": "CA",
            "postal_code": "953400675",
            "telephone_number": "209-628-9204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3349 G ST STE F",
            "city": "MERCED",
            "state": "CA",
            "postal_code": "953400978",
            "telephone_number": "209-349-8459",
            "fax_number": "209-580-4671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROUSSARD",
        "first_name": "GINA",
        "middle_name": "LEISHA",
        "name_prefix": "Ms.",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-08-31",
        "last_updated": "2024-08-09",
        "certification_date": "2024-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "565760",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shanella Briones
• Bristol Hospice - California, LLC
• Ronald E Brons, MD
• Amanda Brooks
• Katherine Louise Brothers, HOME HEALTH AIDE
• Julia Brown
• Richard Joseph Brown
• Sarah Ann Mattrycia Brown
• Sharon Lee Brown, NP
• Zakia Brown

• Family Nurse Practitioner in Merced, CA
• Providers in Merced, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.