Deborah Ann Broadley, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

3754 Issued in CT

Practice address

30 Jordan LN
Wethersfield, CT 06109-1278

Phone

(860) 263-0253

Fax

(860) 263-0262

NPI assigned

Feb 29, 2008

Last updated

Dec 2, 2014By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Masonicare Behavioral Health, LLC

  • Geriatric Psychiatry Physician
  • Wallingford, CT
  • NPI 1992781488
  NPD
• Masonicare Primary Care Physicians

  • Geriatric Medicine (Internal Medicine) Physician
  • Wallingford, CT
  • NPI 1922084540
  NPD

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

{
    "created_epoch": "1204243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1417478400000",
    "number": "1558531996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 JORDAN LN",
            "city": "WETHERSFIELD",
            "state": "CT",
            "postal_code": "061091278",
            "telephone_number": "860-263-0253",
            "fax_number": "860-263-0262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 JORDAN LN",
            "city": "WETHERSFIELD",
            "state": "CT",
            "postal_code": "061091278",
            "telephone_number": "860-263-0253",
            "fax_number": "860-263-0262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROADLEY",
        "first_name": "DEBORAH",
        "middle_name": "ANN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-29",
        "last_updated": "2014-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CT",
            "license": "3754",
            "primary": true
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "CT",
            "license": "003754",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008004412",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• BKFG Patient Care Solutions (Best Life Caregivers)
• Tamika Blackburn, M.D.
• Christina Nithda Bouaphone, APRN
• Alicia Bravo, ANP-BC
• Brighid Brennan, RD, LDN
• Rohan Brown, M.A., M.DIV, LPC
• Thomas Andrew Brown, M.D.
• Melissa Marie Broxton, OTR
• Jared Paul Buchanan
• Mallika Budhai

• Family Nurse Practitioner in Wethersfield, CT
• Providers in Wethersfield, CT by specialty
• Family Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2014; 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.