Provider Demographics
NPI:1093125825
Name:BROWN, JACQUELINE FLORENCE
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:FLORENCE
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 S 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-2909
Mailing Address - Country:US
Mailing Address - Phone:914-882-0387
Mailing Address - Fax:914-371-1633
Practice Address - Street 1:56 S 11TH AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-2909
Practice Address - Country:US
Practice Address - Phone:914-882-0387
Practice Address - Fax:914-371-1633
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-01
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY269188-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse