Healthcare Provider Details

I. General information

NPI: 1265022206
Provider Name (Legal Business Name): SHAWN BROWN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2021
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 SW SAINT LUCIE WEST BLVD
PORT ST LUCIE FL
34986-1766
US

IV. Provider business mailing address

3461 SW ENGLEWOOD ST
PORT ST LUCIE FL
34953-4940
US

V. Phone/Fax

Practice location:
  • Phone: 772-932-5847
  • Fax:
Mailing address:
  • Phone: 772-708-8279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number11040959
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9453562
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number11040959
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number11040959
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: