Provider Demographics
NPI:1285053645
Name:BROUGHTON, RHONDA (ARNP, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:
Last Name:BROUGHTON
Suffix:
Gender:F
Credentials:ARNP, FNP-C
Other - Prefix:MS
Other - First Name:RHONDA
Other - Middle Name:DEES
Other - Last Name:SINGLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1270 BLUE HERON LN N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-8505
Mailing Address - Country:US
Mailing Address - Phone:904-246-8436
Mailing Address - Fax:
Practice Address - Street 1:580 W 8TH ST
Practice Address - Street 2:TOWER 1, 5TH FLOOR, STE 513
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6533
Practice Address - Country:US
Practice Address - Phone:904-633-0797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-14
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3187952363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003152232AMedicaid
FL012796700Medicaid
FL012796700Medicaid
GA003152232AMedicaid