Healthcare Provider Details

I. General information

NPI: 1396656997
Provider Name (Legal Business Name): LATISHA TIERRA AUDRIENA BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2126 DIXIE AVE
SARASOTA FL
34234-7572
US

IV. Provider business mailing address

2126 DIXIE AVE
SARASOTA FL
34234-7572
US

V. Phone/Fax

Practice location:
  • Phone: 941-298-8102
  • Fax:
Mailing address:
  • Phone: 941-298-8102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberB650538927180
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: