Tina Andrea Broderick
Dental Hygienist
6401 S Richards Ave
Santa Fe
, New Mexico 87508-4887
Tina Andrea Broderick
Dental Hygienist
6401 S Richards Ave
Santa Fe
, New Mexico 87508-4887
(505) 988-3246
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About
Features
Specialties
- Dental Hygienist
Languages spoken
- English
Location
First Address
- Tina Andrea Broderick
- Po Box 5395
- Santa Fe, NM
- Zip : 87502-5395
- Fax : (505) 988-3246
- Phone : (505) 984-5048
Second Address
- Tina Andrea Broderick
- 6401 S Richards Ave
- Santa Fe, NM
- Zip : 87508-4887
- Fax : (505) 988-3246
- Phone : (505) 984-5048
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 124Q00000X | Dental Hygienist | ||
| Y | 124Q00000X | Dental Hygienist | DH1049 | NM |
National Provider Identifier
| NPI | 1063085413 |
|---|---|
| Provider Name | Tina Andrea Broderick |
| First Address | Santa Fe, NM 87502-5395 |
| Second Address | Santa Fe, NM 87508-4887 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 22/07/2021 |
| Last Update Date | 22/07/2021 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.