1790949238 NPI number — PATRICIA W. BROWN, PHD, ARNP, LLC

Table of content: (NPI 1790949238)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790949238 NPI number — PATRICIA W. BROWN, PHD, ARNP, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATRICIA W. BROWN, PHD, ARNP, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790949238
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
207 W. GORE STREET
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32806
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-425-5100
Provider Business Mailing Address Fax Number:
407-425-3009

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4421 SUN N LAKE BLVD
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
SEBRING
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33872-2166
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-485-1058
Provider Business Practice Location Address Fax Number:
863-655-2962
Provider Enumeration Date:
07/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
WHISONANT
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
407-737-9297

Provider Taxonomy Codes

  • Taxonomy code: 364SP0808X , with the licence number:  ARNP1104872 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 764346200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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