MEDICARE: DEIDRA A. BROWN-BRINSON APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	ARNP1264352	FL
2	363LA2200X	Adult Health Nurse Practitioner	APRN1264352	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124024203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEIDRA A. BROWN-BRINSON APRN

Provider Business Mailing Address
First Line	:	PO BOX 102222
Second Line	:	ATTN: CREDENTIALING DEPARTMENT
City	:	ATLANTA
State	:	GA
Zip	:	30368-2222
Country	:	US
Telephone Number	:	239-274-8200
Fax Number	:

Provider Business Practice Location Address
First Line	:	3401 PGA BLVD STE 200
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33410-2824
Country	:	US
Telephone Number	:	561-366-4100
Fax Number	:	561-776-8801

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	02/09/2026

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