Provider Demographics
NPI:1316400765
Name:BROWN, COLLIN MARSHALL
Entity Type:Individual
Prefix:MR
First Name:COLLIN
Middle Name:MARSHALL
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19551 BOWRING PARK RD APT 105
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33967-5231
Mailing Address - Country:US
Mailing Address - Phone:765-667-8613
Mailing Address - Fax:
Practice Address - Street 1:15821 HOLLYFERN CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3732
Practice Address - Country:US
Practice Address - Phone:239-432-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-12
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant