Provider Demographics
NPI:1073543674
Name:BROWN, MARY SUE (ARNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:SUE
Last Name:BROWN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 517
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32035-0517
Mailing Address - Country:US
Mailing Address - Phone:904-548-1800
Mailing Address - Fax:904-277-7286
Practice Address - Street 1:86014 PAGES DAIRY RD
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-5203
Practice Address - Country:US
Practice Address - Phone:904-548-1880
Practice Address - Fax:904-225-0850
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 364962163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY4294ZMedicare ID - Type Unspecified
FLP27998Medicare UPIN