Jacob David Broadrick, MSN RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

041492589 Issued in IL

Practice address

4600 N Ravenswood Ave
Chicago, IL 60640-4510

Phone

(773) 561-7500

Fax

(773) 561-7612

NPI assigned

Jan 16, 2025

Last updated

Jan 16, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Credentials

Master of Science - Nursing, Registered Nurse

State licenses

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

{
    "created_epoch": "1736985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736985600000",
    "number": "1598576860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4606 N HERMITAGE AVE APT 214",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606404567",
            "telephone_number": "319-321-1700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4600 N RAVENSWOOD AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606404510",
            "telephone_number": "773-561-7500",
            "fax_number": "773-561-7612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROADRICK",
        "first_name": "JACOB",
        "middle_name": "DAVID",
        "credential": "MSN RN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-01-16",
        "last_updated": "2025-01-16",
        "certification_date": "2025-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041492589",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Broad Horizons Psychotherapy
• Allison Broad, MD
• Sierra Rae Broad, DO
• Tanya Marraccini Broaded, D.C.
• Monica Broadie, RN
• Broadway Chiropractic Inc
• Broadway Medical Group
• Broadway Medical Office S C
• Broadway Pharmacy Inc
• Wahab Brobbey, MD

• Registered Nurse in Chicago, IL
• Providers in Chicago, IL by specialty
• Registered Nurse in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2025; 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.