Tia Lea Broadnax

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

218830 Issued in NC

Practice address

1203 Maple St
Greensboro, NC 27405-6910

Phone

(336) 840-5591

NPI assigned

May 31, 2023

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1685491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685491200000",
    "number": "1144913708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1203 MAPLE ST",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274056910",
            "telephone_number": "336-840-5591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1203 MAPLE ST",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274056910",
            "telephone_number": "336-840-5591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROADNAX",
        "first_name": "TIA",
        "middle_name": "LEA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-05-31",
        "last_updated": "2023-05-31",
        "certification_date": "2023-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NC",
            "license": "218830",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittany Hargrove
• Britthaven, Inc.
• Britthaven, Inc.
• Candice Dawn Broadnax, MED CCC-SLP
• Shonda Broadnax
• Tiffany Broadnax, CMA
• Christine Broadwater, L.P.C.
• Thomas E Brock, M.D.
• Taylor Kellen Broderick
• Bruce Rogers Brodie, M.D.

• Registered Nurse in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Registered Nurse in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.