Provider Demographics
NPI:1215360987
Name:BROWN, BEVERLY DELORES (CAREGIVER)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:DELORES
Last Name:BROWN
Suffix:
Gender:F
Credentials:CAREGIVER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4671 SW 100TH LANE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476
Mailing Address - Country:US
Mailing Address - Phone:352-426-0600
Mailing Address - Fax:
Practice Address - Street 1:4671 SW 100TH LN
Practice Address - Street 2:4671 SW 100TH LANE
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476-4157
Practice Address - Country:US
Practice Address - Phone:352-426-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906623172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty