Healthcare Provider Details

I. General information

NPI: 1346053048
Provider Name (Legal Business Name): MARK RICHARD BROWN FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2025
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 NUT TREE RD
VACAVILLE CA
95687-3508
US

IV. Provider business mailing address

421 NUT TREE RD
VACAVILLE CA
95687-3508
US

V. Phone/Fax

Practice location:
  • Phone: 707-624-7500
  • Fax:
Mailing address:
  • Phone: 707-624-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95033749
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: