Provider Demographics
NPI:1578780508
Name:BROWN, STACEY DEESE (ARNP)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:DEESE
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 1:371 MAGNOLIA DR
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-8379
Mailing Address - Country:US
Mailing Address - Phone:561-575-1769
Mailing Address - Fax:
Practice Address - Street 1:11030 RCA CENTER DR
Practice Address - Street 2:SUITE 3015
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4276
Practice Address - Country:US
Practice Address - Phone:561-776-7041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3279132363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily