Healthcare Provider Details

I. General information

NPI: 1245694595
Provider Name (Legal Business Name): KASSANDRA BROWN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2016
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date: 11/28/2016
Reactivation Date: 07/12/2017

III. Provider practice location address

1707 N MAIN ST
GAINESVILLE FL
32609-3650
US

IV. Provider business mailing address

PO BOX 100237
GAINESVILLE FL
32610-3001
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-9522
  • Fax: 352-265-9575
Mailing address:
  • Phone: 352-265-9522
  • Fax: 352-265-9575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME141006
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: