MEDICARE: ALICIA 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	363AM0700X	Medical Physician Assistant	PA9101637	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA9101637	OTHER	FL	FLORIDA LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639254980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA BROWN

Provider Business Mailing Address
First Line	:	151 SOUTHHALL LN STE 300
Second Line	:
City	:	MAITLAND
State	:	FL
Zip	:	32751-7172
Country	:	US
Telephone Number	:	78-752-0804
Fax Number	:	407-650-3455

Provider Business Practice Location Address
First Line	:	600 W PLYMOUTH AVE
Second Line	:
City	:	DELAND
State	:	FL
Zip	:	32720-3260
Country	:	US
Telephone Number	:	386-738-0322
Fax Number	:	386-738-0628

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

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	07/12/2019

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Directions to “ ALICIA BROWN ” Practice Location

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