Healthcare Provider Details

I. General information

NPI: 1497275317
Provider Name (Legal Business Name): JEILYN M BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12426 HORSESHOE BEND DR
LITHIA FL
33547-3305
US

IV. Provider business mailing address

12426 HORSESHOE BEND DR
LITHIA FL
33547-3305
US

V. Phone/Fax

Practice location:
  • Phone: 813-407-7275
  • Fax:
Mailing address:
  • Phone: 813-407-7275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-71205
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: