Provider Demographics
NPI:1164175279
Name:BROYARD, TAWANDA A (CPT,CPI,CNA)
Entity Type:Individual
Prefix:MRS
First Name:TAWANDA
Middle Name:A
Last Name:BROYARD
Suffix:
Gender:F
Credentials:CPT,CPI,CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 LADY LN
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-2016
Mailing Address - Country:US
Mailing Address - Phone:469-245-1648
Mailing Address - Fax:
Practice Address - Street 1:1118 LADY LN
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-2016
Practice Address - Country:US
Practice Address - Phone:469-245-1648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21-5944246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy