Healthcare Provider Details

I. General information

NPI: 1922356989
Provider Name (Legal Business Name): SUSAN AMANDA BROWN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2012
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2435 BEXLEY VILLAGE DR # 200
LAND O LAKES FL
34638-2721
US

IV. Provider business mailing address

2435 BEXLEY VILLAGE DR # 200
LAND O LAKES FL
34638-2721
US

V. Phone/Fax

Practice location:
  • Phone: 813-467-4771
  • Fax: 813-467-4783
Mailing address:
  • Phone: 813-467-4771
  • Fax: 813-467-4783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11010315
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number17991
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: