Provider Demographics
NPI:1407894272
Name:BROWN, JAMES THOMAS JR (NURSE ANESTHETIST)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:THOMAS
Last Name:BROWN
Suffix:JR
Gender:M
Credentials:NURSE ANESTHETIST
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Mailing Address - Street 1:880 SW GRAND RESERVE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2339
Mailing Address - Country:US
Mailing Address - Phone:772-340-7788
Mailing Address - Fax:772-343-7419
Practice Address - Street 1:880 SW GRAND RESERVE BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2339
Practice Address - Country:US
Practice Address - Phone:772-340-7788
Practice Address - Fax:772-343-7419
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2018-11-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL1447922367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL301032500Medicaid
FLG0536CMedicare PIN