Provider Demographics
NPI:1659789261
Name:BROWN, AVIS SPRADLEY (AGPCNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:AVIS
Middle Name:SPRADLEY
Last Name:BROWN
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:MRS
Other - First Name:AVIS
Other - Middle Name:SPRADLEY
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:5870 HIATUS RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-6424
Mailing Address - Country:US
Mailing Address - Phone:954-377-3172
Mailing Address - Fax:877-519-4595
Practice Address - Street 1:5301 S CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-1149
Practice Address - Country:US
Practice Address - Phone:561-588-4844
Practice Address - Fax:561-588-3655
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-27
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9173507363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care