Individual
MRS. DENISE MICHELLE MCBROOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
390 CHALLENGER RD, CAPE CANAVERAL, FL 32920-4200
(321) 633-8640
Mailing address
602 E. 72ND STREET, SAVANNAH, GA 31405-4913
(912) 819-7878
(912) 819-5044
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
003185
GA
363A00000X
Physician Assistant
Primary
9111719
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
972007681A
—
GA
Enumeration date
01/02/2008
Last updated
01/25/2022
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