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General NPI Number Information
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NPI Number | 1558546267
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Entity Type | Individual
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Provider Name | DENISE MICHELLE MCBROOM PA
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Gender | Female
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Dates
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Enumeration Date | 01/02/2008
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Last Update Date | 01/25/2022
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Provider Practice Location Address
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Address Line | 390 CHALLENGER RD
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City | CAPE CANAVERAL
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State | FL
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Zip | 32920-4200
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Country | US
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Telephone | 321-633-8640
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Fax |
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Provider Business Mailing Address
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Address Line | 602 E. 72ND STREET
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City | SAVANNAH
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State | GA
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Zip | 31405-4913
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Country | US
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Telephone | 912-819-7878
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Fax | 912-819-5044
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 003185
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 9111719
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License Number State | FL
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