Provider Demographics
NPI:1013499698
Name:BROWN, MADISON GRACE
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:GRACE
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 1:3347 MAGNOLIA SPRINGS DR APT 203
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-0019
Mailing Address - Country:US
Mailing Address - Phone:601-951-6327
Mailing Address - Fax:
Practice Address - Street 1:3347 MAGNOLIA SPRINGS DR APT 203
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-0019
Practice Address - Country:US
Practice Address - Phone:601-951-6327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer