Provider Demographics
NPI:1548562747
Name:BROWN, PAMELA (ARNP)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 WELLNESS WAY STE 107
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-3783
Mailing Address - Country:US
Mailing Address - Phone:772-226-4200
Mailing Address - Fax:772-226-4204
Practice Address - Street 1:801 WELLNESS WAY STE 4
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3730
Practice Address - Country:US
Practice Address - Phone:772-226-4200
Practice Address - Fax:772-226-4202
Is Sole Proprietor?:No
Enumeration Date:2010-11-22
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9262848363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1568562747Medicaid