Provider Demographics
NPI:1942931886
Name:BROWN, MICHELLE WYNNETTE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:WYNNETTE
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 1:6911 SW 64TH TER
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476-6086
Mailing Address - Country:US
Mailing Address - Phone:772-621-0917
Mailing Address - Fax:
Practice Address - Street 1:6911 SW 64TH TER
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476-3447
Practice Address - Country:US
Practice Address - Phone:772-621-0917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities