Provider Demographics
NPI:1205335619
Name:BROWN, ANNETTA AILEEN
Entity type:Individual
Prefix:
First Name:ANNETTA
Middle Name:AILEEN
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 1:8859 OLD KINGS RD S APT 909
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-1751
Mailing Address - Country:US
Mailing Address - Phone:904-502-3363
Mailing Address - Fax:
Practice Address - Street 1:4901 SUNBEAM RD APT 1016
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257
Practice Address - Country:US
Practice Address - Phone:904-502-3363
Practice Address - Fax:904-527-1686
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-12
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child