Healthcare Provider Details

I. General information

NPI: 1326519166
Provider Name (Legal Business Name): BROWN FERTILITY ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2018
Last Update Date: 03/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8149 POINT MEADOWS WAY
JACKSONVILLE FL
32256-9111
US

IV. Provider business mailing address

8149 POINT MEADOWS WAY
JACKSONVILLE FL
32256-9111
US

V. Phone/Fax

Practice location:
  • Phone: 904-260-0352
  • Fax:
Mailing address:
  • Phone: 904-260-0352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL E BROWN
Title or Position: PRESIDENT
Credential: MD
Phone: 904-260-0352