Healthcare Provider Details

I. General information

NPI: 1306718309
Provider Name (Legal Business Name): JERMAINE BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 N DON WICKHAM DR
CLERMONT FL
34711-1922
US

IV. Provider business mailing address

PO BOX 491000
LEESBURG FL
34749-1000
US

V. Phone/Fax

Practice location:
  • Phone: 352-394-5922
  • Fax: 352-394-1103
Mailing address:
  • Phone: 352-315-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCAP0001848
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: