Provider Demographics
NPI:1154861425
Name:BROWN, SHIRLEY D (RN17070122)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:D
Last Name:BROWN
Suffix:
Gender:F
Credentials:RN17070122
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 LASALLE LEFALL DR
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:FL
Mailing Address - Zip Code:32351-5324
Mailing Address - Country:US
Mailing Address - Phone:850-875-7200
Mailing Address - Fax:850-875-7210
Practice Address - Street 1:278 LASALLE LEFALL DR
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32351-5324
Practice Address - Country:US
Practice Address - Phone:850-875-7200
Practice Address - Fax:850-875-7210
Is Sole Proprietor?:No
Enumeration Date:2017-03-06
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1707122163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health