Healthcare Provider Details

I. General information

NPI: 1184454852
Provider Name (Legal Business Name): SHANNON MARIE BROWN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON MARIE KIRKPATRICK

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14011 BEACH BLVD STE 120
JACKSONVILLE FL
32250-1695
US

IV. Provider business mailing address

330 CORPORATE WAY STE 200
ORANGE PARK FL
32073-6214
US

V. Phone/Fax

Practice location:
  • Phone: 904-223-6400
  • Fax: 904-223-6420
Mailing address:
  • Phone: 904-282-6331
  • Fax: 904-866-4818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11029522
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11029522
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: