Provider Demographics
NPI:1821295866
Name:BROWN, JAMES CORNELIUS II (PA-C)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:CORNELIUS
Last Name:BROWN
Suffix:II
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 STALLION WAY
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33594-4396
Mailing Address - Country:US
Mailing Address - Phone:813-546-6891
Mailing Address - Fax:813-657-8893
Practice Address - Street 1:24420 SR 54
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33559-7303
Practice Address - Country:US
Practice Address - Phone:813-949-4100
Practice Address - Fax:813-949-4144
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100900363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE2336QOtherMEDICARE PTAN LINKED TO GROUP PTAN GA609A