Provider Demographics
NPI:1710320908
Name:BROUSSARD FAMILY PRACTICE, PLLC
Entity Type:Organization
Organization Name:BROUSSARD FAMILY PRACTICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIETTE
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:BROUSSARD
Authorized Official - Suffix:
Authorized Official - Credentials:FNPC
Authorized Official - Phone:409-833-0342
Mailing Address - Street 1:PO BOX 7096
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77726-7096
Mailing Address - Country:US
Mailing Address - Phone:409-833-0342
Mailing Address - Fax:877-770-4091
Practice Address - Street 1:810 HOSPITAL DR STE 100
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4633
Practice Address - Country:US
Practice Address - Phone:409-833-0342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2891174400000X
TX651610363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty