Provider Demographics
NPI:1003568320
Name:BROOM, ALEXANDREA CROMER (NP-C)
Entity Type:Individual
Prefix:
First Name:ALEXANDREA
Middle Name:CROMER
Last Name:BROOM
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:ALEXANDREA
Other - Middle Name:MARIE
Other - Last Name:CROMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:22580 HIGHWAY 76 E STE 300
Mailing Address - Street 2:
Mailing Address - City:LAURENS
Mailing Address - State:SC
Mailing Address - Zip Code:29360-8460
Mailing Address - Country:US
Mailing Address - Phone:864-939-1070
Mailing Address - Fax:864-939-1079
Practice Address - Street 1:22580 HIGHWAY 76 E STE 300
Practice Address - Street 2:
Practice Address - City:LAURENS
Practice Address - State:SC
Practice Address - Zip Code:29360-8460
Practice Address - Country:US
Practice Address - Phone:864-939-1070
Practice Address - Fax:864-939-1079
Is Sole Proprietor?:No
Enumeration Date:2022-01-19
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25725363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily