Healthcare Provider Details

I. General information

NPI: 1346160371
Provider Name (Legal Business Name): TAMARA NICOLE BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 SE 19TH TER
GAINESVILLE FL
32641-8377
US

IV. Provider business mailing address

431 NE 45TH TER
GAINESVILLE FL
32641-1987
US

V. Phone/Fax

Practice location:
  • Phone: 352-213-8199
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA109861
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: