Healthcare Provider Details

I. General information

NPI: 1063405686
Provider Name (Legal Business Name): JENNIFER FIELD BROWN PHM-CNS/ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 12/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1072 LASKIN RD SUITE 104
VIRGINIA BEACH VA
23451-6364
US

IV. Provider business mailing address

1072 LASKIN RD SUITE 104
VIRGINIA BEACH VA
23451-6364
US

V. Phone/Fax

Practice location:
  • Phone: 757-648-8605
  • Fax: 757-648-1363
Mailing address:
  • Phone: 757-648-8605
  • Fax: 757-648-1363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number0015000720
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024168259
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: