Provider Demographics
NPI:1467449975
Name:BROAD, MICHELE RACHEAL (NP)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:RACHEAL
Last Name:BROAD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6136 KETTLE FIRE TRL
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80925-1351
Mailing Address - Country:US
Mailing Address - Phone:951-533-6113
Mailing Address - Fax:
Practice Address - Street 1:24910 LAS BRISAS ROAD
Practice Address - Street 2:STE 105
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-4010
Practice Address - Country:US
Practice Address - Phone:951-231-1385
Practice Address - Fax:566-345-3272
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA428809363LA2200X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health