Healthcare Provider Details

I. General information

NPI: 1114545050
Provider Name (Legal Business Name): REGINA JILL BROWN FNP-C, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2020
Last Update Date: 02/24/2024
Certification Date: 02/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2535 GEORGETOWN RD NW
CLEVELAND TN
37311-3534
US

IV. Provider business mailing address

PO BOX 761
CLEVELAND TN
37364-0761
US

V. Phone/Fax

Practice location:
  • Phone: 423-244-0311
  • Fax: 615-216-8538
Mailing address:
  • Phone: 423-310-6032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number27876
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number27876
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: