Provider Demographics
NPI:1215554746
Name:STEWART-BROWN, DAWN ANN
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:ANN
Last Name:STEWART-BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32908
Mailing Address - Country:US
Mailing Address - Phone:321-549-9612
Mailing Address - Fax:
Practice Address - Street 1:1425 MALABAR RD NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-2506
Practice Address - Country:US
Practice Address - Phone:321-434-8015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11007771363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily