Healthcare Provider Details

I. General information

NPI: 1811407448
Provider Name (Legal Business Name): AZALEE L BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2017
Last Update Date: 10/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 BAY RD
MOUNT DORA FL
32757-2105
US

IV. Provider business mailing address

3283 SPICER AVE
GRAND ISLAND FL
32735-9018
US

V. Phone/Fax

Practice location:
  • Phone: 352-483-5633
  • Fax:
Mailing address:
  • Phone: 352-408-4805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9264744
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: