Provider Demographics
NPI:1194826602
Name:BROWN, DANIEL NATHAN (PA-C)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:NATHAN
Last Name:BROWN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6405 N FEDERAL HWY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-1412
Mailing Address - Country:US
Mailing Address - Phone:954-772-2411
Mailing Address - Fax:954-772-3766
Practice Address - Street 1:6405 N FEDERAL HWY
Practice Address - Street 2:SUITE 205
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-1412
Practice Address - Country:US
Practice Address - Phone:954-772-2411
Practice Address - Fax:954-772-3766
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103878363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9103878OtherPHYSICIAN ASSISTANT LIC