Healthcare Provider Details

I. General information

NPI: 1275453219
Provider Name (Legal Business Name): ALEXANDRIA BROOME APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18901 LAKE SHORE BLVD
EUCLID OH
44119-1078
US

IV. Provider business mailing address

18901 LAKE SHORE BLVD
EUCLID OH
44119-1078
US

V. Phone/Fax

Practice location:
  • Phone: 216-956-3454
  • Fax:
Mailing address:
  • Phone: 216-956-3454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberAPRN.CNS.0019546
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: