Provider Demographics
NPI:1609167485
Name:BROWN, CARRIE NICOLE (MS)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:NICOLE
Last Name:BROWN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 JUMANA LOOP
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-2915
Mailing Address - Country:US
Mailing Address - Phone:813-382-7635
Mailing Address - Fax:
Practice Address - Street 1:206 RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-4617
Practice Address - Country:US
Practice Address - Phone:813-662-1060
Practice Address - Fax:813-662-0530
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ 5255235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist