Individual
MRS. SANDRA ALLENE BROCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
101 TWILIGHT ST NE, PALM BAY, FL 32907-1151
(321) 984-0430
Mailing address
101 TWILIGHT ST NE, PALM BAY, FL 32907-1151
(321) 984-0430
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
230526700
FLORIDA MEDICAID PROVIDER NUMBER
FL
Enumeration date
06/26/2008
Last updated
06/26/2008
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