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General NPI Number Information
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NPI Number | 1477439511
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Entity Type | Organization
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Legal Business Name | ST BROACH LLC
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Dates
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Enumeration Date | 08/13/2025
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 908 S PARKER DR
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City | FLORENCE
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State | SC
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Zip | 29501-6007
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Country | US
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Telephone | 843-260-8041
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Fax |
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Provider Business Mailing Address
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Address Line | 1841 SLOANE LN
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City | FLORENCE
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State | SC
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Zip | 29501-6532
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Country | US
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Telephone | 843-260-8041
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. TASHA M BROACH
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Credential | NP-C
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Telephone | 843-260-8041
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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