Provider Demographics
NPI:1083980387
Name:BROXTON, TERESA M
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:M
Last Name:BROXTON
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 1:401 N RIDGEWOOD AVENUE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114
Mailing Address - Country:US
Mailing Address - Phone:386-253-2828
Mailing Address - Fax:386-252-5626
Practice Address - Street 1:401 N RIDGEWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114
Practice Address - Country:US
Practice Address - Phone:386-253-2828
Practice Address - Fax:386-252-5626
Is Sole Proprietor?:No
Enumeration Date:2012-03-30
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator