Provider Demographics
NPI:1942578737
Name:BROWN, JACQUELINE ANN (FNP)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ANN
Last Name:BROWN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 CANAL ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-4153
Mailing Address - Country:US
Mailing Address - Phone:912-450-0999
Mailing Address - Fax:912-450-0998
Practice Address - Street 1:114 CANAL ST
Practice Address - Street 2:SUITE 402
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4153
Practice Address - Country:US
Practice Address - Phone:912-450-0999
Practice Address - Fax:912-450-0998
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN194174363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily