Provider Demographics
NPI:1083078653
Name:BROSSOIT, JANE
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:BROSSOIT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8026 LITTLEDOE CT
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-2318
Mailing Address - Country:US
Mailing Address - Phone:727-452-6663
Mailing Address - Fax:
Practice Address - Street 1:233 STUARTSBURG RD
Practice Address - Street 2:
Practice Address - City:BUENA VISTA
Practice Address - State:VA
Practice Address - Zip Code:24416-4604
Practice Address - Country:US
Practice Address - Phone:540-261-5330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5172735164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse