=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164692463
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEANELLE DENISE BROWN MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2008
-----------------------------------------------------
Last Update Date | 08/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 OCEANS WEST BLVD APT 2000
-----------------------------------------------------
City | DAYTONA BEACH SHORES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32118-7945
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-284-7419
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 OCEANS WEST BLVD APT 2000
-----------------------------------------------------
City | DAYTONA BEACH SHORES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32118-7945
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-284-7419
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | ME103239
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------