MEDICARE: JESSICA BROWN

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	363LF0000X	Family Nurse Practitioner	024923	OH

General Provider Information

NPI Number	:	1487215406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA BROWN

Provider Business Mailing Address
First Line	:	333 N SUMMIT ST FL 7
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43604-1531
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6755 W CENTRAL AVE STE 101
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43617-1443
Country	:	US
Telephone Number	:	567-585-0075
Fax Number	:	419-517-7105

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

Provider Enumeration Date	:	06/21/2019
Last Update Date	:	11/03/2023

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Directions to “ JESSICA BROWN ” Practice Location

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