Healthcare Provider Details

I. General information

NPI: 1689310559
Provider Name (Legal Business Name): SHERRY M BROWN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2022
Last Update Date: 06/07/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 SW STATE ROAD 47
LAKE CITY FL
32025-0453
US

IV. Provider business mailing address

PO BOX 102222
ATLANTA GA
30368-2222
US

V. Phone/Fax

Practice location:
  • Phone: 386-401-7066
  • Fax: 833-933-0709
Mailing address:
  • Phone: 239-274-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11018587
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: