Provider Demographics
NPI:1093570483
Name:BROWN, JACQUELINE HOPE MAUREEN (NP)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:HOPE MAUREEN
Last Name:BROWN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3510 STONEHAM DR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-5149
Mailing Address - Country:US
Mailing Address - Phone:706-405-1703
Mailing Address - Fax:
Practice Address - Street 1:3510 STONEHAM DR
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-5149
Practice Address - Country:US
Practice Address - Phone:706-405-1703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-15
Last Update Date:2024-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN174297363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily