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NPI Code Detail

MEDICARE: KRISTINA M BROWN BA

MEDICARE: KRISTINA M BROWN BA
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
1222Q00000XDevelopmental Therapist

General Provider Information

NPI Number : 1902227085
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTINA M BROWN BA
Provider Business Mailing Address
First Line : 3771 SAN JOSE PL STE 22
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32257-2439
Country : US
Telephone Number : 904-928-0112
Fax Number : 904-928-0112
Provider Business Practice Location Address
First Line : 3771 SAN JOSE PL STE 22
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32257-2439
Country : US
Telephone Number : 904-928-0112
Fax Number : 904-928-0112
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/17/2013
Last Update Date : 12/17/2013

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Directions to “ KRISTINA M BROWN BA” Practice Location

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