Provider Demographics
NPI:1750848511
Name:BROXEY, QUINTON DEANGELO
Entity Type:Individual
Prefix:
First Name:QUINTON
Middle Name:DEANGELO
Last Name:BROXEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 HAWKINS ST SW
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32064-4007
Mailing Address - Country:US
Mailing Address - Phone:407-340-7184
Mailing Address - Fax:
Practice Address - Street 1:614 HAWKINS ST SW
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-4007
Practice Address - Country:US
Practice Address - Phone:407-340-7184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)