Healthcare Provider Details

I. General information

NPI: 1992699334
Provider Name (Legal Business Name): MISS MARY ELIZABETH BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 BELFORT RD BLDG 400
JACKSONVILLE FL
32256-6026
US

IV. Provider business mailing address

1115 W CALL ST
TALLAHASSEE FL
32304-3556
US

V. Phone/Fax

Practice location:
  • Phone: 904-580-4730
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: