Provider Demographics
NPI:1619628435
Name:BROWN, TARANEISHEA
Entity Type:Individual
Prefix:
First Name:TARANEISHEA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4725 HOLLY LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-5374
Mailing Address - Country:US
Mailing Address - Phone:561-932-5231
Mailing Address - Fax:
Practice Address - Street 1:801 NORTHPOINT PKWY STE 74
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-1812
Practice Address - Country:US
Practice Address - Phone:561-619-0796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLB650812689700Medicaid