Provider Demographics
NPI:1700470259
Name:BROWN, JACQUELYN (LPN)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2026
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-2026
Mailing Address - Country:US
Mailing Address - Phone:843-350-2680
Mailing Address - Fax:
Practice Address - Street 1:2 CORPUS CHRISTIE PL STE 200
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29928-1712
Practice Address - Country:US
Practice Address - Phone:843-350-2680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC45170164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse