Provider Demographics
NPI:1447431309
Name:INGS-BROWN, GWENDOLYN MARVETT
Entity Type:Individual
Prefix:MRS
First Name:GWENDOLYN
Middle Name:MARVETT
Last Name:INGS-BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GWENDOLYN
Other - Middle Name:MARVETT
Other - Last Name:INGS-BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:583 SAND WEDGE LOOP
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-6055
Mailing Address - Country:US
Mailing Address - Phone:407-766-7217
Mailing Address - Fax:
Practice Address - Street 1:583 SAND WEDGE LOOP
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-6055
Practice Address - Country:US
Practice Address - Phone:407-766-7217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL690542179171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL690542168Medicaid
FL690542198Medicaid
FL690542196Medicaid
FL690542179Medicaid