Provider Demographics
NPI:1013582154
Name:BROWN, NATALIE ANNE
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:ANNE
Last Name:BROWN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 E FOWLER AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-2305
Mailing Address - Country:US
Mailing Address - Phone:813-978-9700
Mailing Address - Fax:
Practice Address - Street 1:4725 US HIGHWAY 98 S STE 101-102
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33812-4334
Practice Address - Country:US
Practice Address - Phone:813-978-9700
Practice Address - Fax:813-558-6185
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9114700363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant