Individual
MRS. ISABEL BROOME
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1821 BLACK LAKE BLVD, WINTER GARDEN, FL 34787-4678
(407) 905-5134
Mailing address
1821 BLACK LAKE BLVD, WINTER GARDEN, FL 34787-4678
(407) 905-5134
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106052300
—
FL
Enumeration date
01/23/2022
Last updated
01/25/2022
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