Healthcare Provider Details

I. General information

NPI: 1508713132
Provider Name (Legal Business Name): NADIA BROWN-BLACK
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 N LEE ST STE 204
JACKSONVILLE FL
32204-1128
US

IV. Provider business mailing address

425 N LEE ST STE 204
JACKSONVILLE FL
32204-1128
US

V. Phone/Fax

Practice location:
  • Phone: 904-427-1200
  • Fax:
Mailing address:
  • Phone: 904-427-1050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11046032
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: