Provider Demographics
NPI:1114545050
Name:BROWN, REGINA JILL (FNP-C, CPNP-PC)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:JILL
Last Name:BROWN
Suffix:
Gender:F
Credentials:FNP-C, CPNP-PC
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 761
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37364-0761
Mailing Address - Country:US
Mailing Address - Phone:423-310-6032
Mailing Address - Fax:
Practice Address - Street 1:2535 GEORGETOWN RD NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3534
Practice Address - Country:US
Practice Address - Phone:423-244-0311
Practice Address - Fax:615-216-8538
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2024-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27876363LF0000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics