Individual provider · NPI-1

Octavia Broadnaix

Adult Companion · Ocala, FL

NPI number1265018832
StatusActive
Last updated in NPPESMar 23, 2021

Details

NPI
1265018832
Entity type
Individual (NPI-1)
Name
Octavia Broadnaix
Sex
Female
Sole proprietor
No
Enumeration date
Mar 23, 2021
Certification date
Mar 10, 2021
Last updated
Mar 23, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
372600000X Adult Companion––Yes
376J00000X Homemaker––

Practice location

6530 Se Maricamp Rd # 831302
Ocala, FL 34472-2808

Phone 407-866-7583

Mailing address

6530 Se Maricamp Rd # 831302
Ocala, FL 34472-2808

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