Healthcare Provider Details

I. General information

NPI: 1366200842
Provider Name (Legal Business Name): JENNIFER NORRIS BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 03/11/2024
Certification Date: 03/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4961 W ATLANTIC AVE
DELRAY BEACH FL
33445-3894
US

IV. Provider business mailing address

4961 W ATLANTIC AVE
DELRAY BEACH FL
33445-3894
US

V. Phone/Fax

Practice location:
  • Phone: 561-716-5153
  • Fax:
Mailing address:
  • Phone: 561-716-5153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number50441424026
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code374700000X
TaxonomyTechnician
License Number50441424026
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number50441424026
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: