Healthcare Provider Details

I. General information

NPI: 1154701688
Provider Name (Legal Business Name): BROOKE ELISABETH HIEB DOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2015
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S ORANGE AVE STE 1000
ORLANDO FL
32801-5403
US

IV. Provider business mailing address

796 MCINTYRE AVE
WINTER PARK FL
32789-5044
US

V. Phone/Fax

Practice location:
  • Phone: 407-341-6592
  • Fax:
Mailing address:
  • Phone: 407-341-6592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number3616
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: