Provider Demographics
NPI:1831284405
Name:BROWN, PAUL DOUGLAS (ARNP)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:DOUGLAS
Last Name:BROWN
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4828 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2341
Mailing Address - Country:US
Mailing Address - Phone:850-477-8109
Mailing Address - Fax:850-478-2412
Practice Address - Street 1:5147 N 9TH AVE STE 311
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8770
Practice Address - Country:US
Practice Address - Phone:850-477-2597
Practice Address - Fax:850-478-7941
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2945182363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL302744900Medicaid
500006102OtherRAILROAD MEDICARE
FLY015VOtherBCBS OF FLORIDA
AL009906310Medicaid
AL059001871OtherBCBS OF ALABAMA
S74004Medicare UPIN
AL009906310Medicaid