Healthcare Provider Details

I. General information

NPI: 1669145611
Provider Name (Legal Business Name): NICOLE ANTOINETTE BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2021
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 W GANDY BLVD
TAMPA FL
33611-2931
US

IV. Provider business mailing address

13714 SIGLER ST
RIVERVIEW FL
33579-2324
US

V. Phone/Fax

Practice location:
  • Phone: 813-925-1903
  • Fax: 813-749-8370
Mailing address:
  • Phone: 813-541-4105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9208974
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN9208974
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163WC2100X
TaxonomyContinence Care Registered Nurse
License NumberRN9208974
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code163WE0900X
TaxonomyEnterostomal Therapy Registered Nurse
License NumberRN9208974
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberRN9208974
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN9208974
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License NumberRN9208974
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code163WN1003X
TaxonomyNutrition Support Registered Nurse
License NumberRN9208974
License Number StateFL
# 9
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberRN9208974
License Number StateFL
# 10
Primary TaxonomyN
Taxonomy Code163WX1500X
TaxonomyOstomy Care Registered Nurse
License NumberRN9208974
License Number StateFL
# 11
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11032893
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: