Russell Kevin Broxson Jr., FNP BC
Individual provider Active NPI Family Nurse Practitioner · Jay, FL
NPI 1295587293 · NPPES record last updated Apr 16, 2024
Key facts
- NPI
- 1295587293
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 11031992 (FL)
- Practice address
- 14114 Alabama St
Jay, FL 32565-1219 - Phone
- (850) 675-8000
- NPI assigned
- Apr 3, 2024
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 4
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Jay Hospital Inc
Practice addresses (Care Compare)
14114 Alabama St
Jay, FL 32565-1219
Phone (850) 675-8011
Hospital & facility affiliations
- Jay Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241115002240 | FL | Practitioner - Nurse Practitioner | 5698212199 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11031992 | FL | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jay Hospital, Inc. | Current | Accepting new patients | |
| Jay Hospital Inc | Current |
Accepting new patients | |
| Jay Hospital, Inc. | Current |
Accepting new patients |
Locations
14114 Alabama St
Jay, FL 32565
Phone (850) 675-8000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 11031992 | FL | Yes |
Addresses
Primary practice location
14114 Alabama St
Jay, FL 32565-1219
Mailing address
5228 Medicine Bow St
Milton, FL 32570-8149
Phone (850) 449-4801
Other providers in Jay, FL
- Thomas Michael Ashworth
- Katharine Bauer
- Christina Ann Blackburn
- Toni Edwards Bouck
- Matthew Brown
- C&J Medical, LLC
- Serena Cook
- Twyla Cotton
- Ellaine Dupuis
- Dura-Med Southeast Inc
All providers in Jay, FL · Family Nurse Practitioner in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 16, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.