Healthcare Provider Details

I. General information

NPI: 1992633572
Provider Name (Legal Business Name): DECARLOS VERREZZINI BROWN II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3246 S POLK AVE APT 4
LAKELAND FL
33803-4562
US

IV. Provider business mailing address

3246 S POLK AVE APT 4
LAKELAND FL
33803-4562
US

V. Phone/Fax

Practice location:
  • Phone: 863-440-4186
  • Fax:
Mailing address:
  • Phone: 863-440-4186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: