Provider Demographics
NPI:1568019784
Name:EMERSON, JUAREZ BROWN (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:JUAREZ
Middle Name:BROWN
Last Name:EMERSON
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:MS
Other - First Name:JUAREZ
Other - Middle Name:BROWN
Other - Last Name:EMERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:426 PINEBROOK CIRCLE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047
Mailing Address - Country:US
Mailing Address - Phone:678-643-3724
Mailing Address - Fax:
Practice Address - Street 1:426 PINEBROOK CIRCLE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39047
Practice Address - Country:US
Practice Address - Phone:678-643-3724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS376J00000X
MSRN873888163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No376J00000XNursing Service Related ProvidersHomemaker