Provider Demographics
NPI:1538343264
Name:BROUGHTON, BOBBI JO
Entity type:Individual
Prefix:
First Name:BOBBI
Middle Name:JO
Last Name:BROUGHTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13810 KAPOK CT
Mailing Address - Street 2:#15J
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-3889
Mailing Address - Country:US
Mailing Address - Phone:813-714-1298
Mailing Address - Fax:813-532-2729
Practice Address - Street 1:13810 KAPOK CT
Practice Address - Street 2:#15J
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-3889
Practice Address - Country:US
Practice Address - Phone:813-714-1298
Practice Address - Fax:813-532-2729
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy