Provider Demographics
NPI:1578929071
Name:BROADBENT, EMMA (PNP-C)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:BROADBENT
Suffix:
Gender:F
Credentials:PNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3066 E COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78220-1013
Mailing Address - Country:US
Mailing Address - Phone:210-233-7062
Mailing Address - Fax:210-434-1704
Practice Address - Street 1:14811 SAN PEDRO AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-3708
Practice Address - Country:US
Practice Address - Phone:210-233-7000
Practice Address - Fax:210-494-2353
Is Sole Proprietor?:No
Enumeration Date:2016-01-13
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129379363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics