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General NPI Number Information
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NPI Number | 1194005199
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Entity Type | Individual
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Provider Name | MICHELLE WALTZ BROWN PPCNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/22/2011
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 841 PRUDENTIAL DR STE 280
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8350
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Country | US
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Telephone | 904-202-8550
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Fax | 904-393-7808
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Provider Business Mailing Address
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Address Line | 10140 CENTURION PKWY N
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City | JACKSONVILLE
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State | FL
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Zip | 32256-0532
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Country | US
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Telephone | 904-697-4100
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Fax | 904-697-5102
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | APRN11012933
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License Number State | FL
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