Provider Demographics
NPI:1558695320
Name:BROWN, JENNIFER K (ARNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:K
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:PO BOX 606
Mailing Address - Street 2:
Mailing Address - City:GLEN ST MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32040-0606
Mailing Address - Country:US
Mailing Address - Phone:904-654-3181
Mailing Address - Fax:904-653-1814
Practice Address - Street 1:1419 S 6TH ST
Practice Address - Street 2:
Practice Address - City:MACCLENNY
Practice Address - State:FL
Practice Address - Zip Code:32063-4624
Practice Address - Country:US
Practice Address - Phone:904-653-1822
Practice Address - Fax:904-259-1225
Is Sole Proprietor?:No
Enumeration Date:2009-09-28
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2738842363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001293100Medicaid