Individual ProviderLaura Diane BroadhurstSpeech-Language PathologistSpeech, Language and Hearing Service ProvidersPractice Address14444 Beach Blvd, #500, Jacksonville, FL 32250-2079(904) 858-7510PECOS EnrollmentBased on the most recent information from CMS, provider Laura Diane Broadhurst does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1629204029Provider TypeIndividualFull NameBroadhurst, Laura DianeTitleMrs.GenderFemaleSole ProprietorNoEnumeration Date5/31/2009Last Updated5/31/2009Contact InformationPractice LocationPractice Address14444 Beach Blvd, #500, Jacksonville, FL 32250-2079Phone(904) 858-7510FaxUnlisted FaxMailing LocationMailing Address14444 Beach Blvd, #500, Jacksonville, FL 32250-2079Phone(904) 858-7510FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode235Z00000XPrimaryDescriptionSpeech-Language PathologistSpeech, Language and Hearing Service ProvidersLicenseSZ4759Florida