Provider Demographics
NPI:1023064920
Name:BROWN, LA TONYA NICOLE (FNP)
Entity type:Individual
Prefix:MISS
First Name:LA TONYA
Middle Name:NICOLE
Last Name:BROWN
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:22 SHORTS LANDING RD
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29907-2617
Mailing Address - Country:US
Mailing Address - Phone:843-846-8148
Mailing Address - Fax:843-838-8312
Practice Address - Street 1:110 ATRIUM WAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-6301
Practice Address - Country:US
Practice Address - Phone:803-865-9655
Practice Address - Fax:803-865-9653
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2018-01-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SCAPN851363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0405Medicaid
SCNP0405Medicaid
P09999Medicare UPIN