Provider Demographics
NPI:1609319763
Name:BROWN -PONDER, DARLENE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:
Last Name:BROWN -PONDER
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 NW 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-2543
Mailing Address - Country:US
Mailing Address - Phone:954-917-8099
Mailing Address - Fax:
Practice Address - Street 1:611 NW 31ST AVE
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-2543
Practice Address - Country:US
Practice Address - Phone:954-917-8099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-22
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1697752163W00000X, 163WA2000X
FL9143261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No163W00000XNursing Service ProvidersRegistered Nurse
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator