Provider Demographics
NPI:1568673663
Name:BROWN, MARGARET C (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:C
Last Name:BROWN
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11945 SAN JOSE BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-1613
Mailing Address - Country:US
Mailing Address - Phone:904-396-1725
Mailing Address - Fax:904-399-1717
Practice Address - Street 1:4012 N 9TH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2824
Practice Address - Country:US
Practice Address - Phone:850-444-4777
Practice Address - Fax:850-434-3387
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9103865363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292808600Medicaid
FLPA9103865OtherSTATE LICENSE
FLPA9103865OtherSTATE LICENSE