Provider Demographics
NPI:1639754864
Name:BROWN, DAWN D
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:D
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 1:12622 SAULSTON PL
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34669-5011
Mailing Address - Country:US
Mailing Address - Phone:270-304-8847
Mailing Address - Fax:
Practice Address - Street 1:12622 SAULSTON PL
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34669-5011
Practice Address - Country:US
Practice Address - Phone:270-304-8847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health