Most Relevant Information
Provider Data
| NPI Number: | 1003383688 |
| Provider Name: | LATRICIA BROADDUS |
| Entity Type: | Individual |
| Taxonomy Code: | 363LP0808X |
| Specialty: | Nurse Practitioner |
| License Number: | 0024181570 |
Most Important Dates
| Enumeration Date: | 10/31/2018 |
| Last Updated: | 03/06/2024 |
Provider Practice Location
5833 RICHMOND TAPPAHANNOCK HWY STE 106B
AYLETT
VA
230093007
Practice Location Phone/Fax
| Phone: | 0422300298 |
| Fax: |
Provider Mailing Location
PO BOX 13
SAINT STEPHENS CHURCH
VA
231480013
Provider Mailing Phone/Fax
| Phone: | 8046642271 |
| Fax: |