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General NPI Number Information
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NPI Number | 1346957552
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Entity Type | Individual
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Provider Name | TISHARA BROWN LPN
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Gender | Female
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Dates
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Enumeration Date | 10/28/2022
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Last Update Date | 10/28/2022
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Provider Practice Location Address
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Address Line | 8 PINE BRANCH PL
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City | PALM COAST
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State | FL
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Zip | 32164-4830
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Country | US
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Telephone | 904-392-1066
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Fax |
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Provider Business Mailing Address
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Address Line | 8 PINE BRANCH PL
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City | PALM COAST
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State | FL
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Zip | 32164-4830
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Country | US
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Telephone | 904-392-1066
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Fax |
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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 | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number | F8J3R2G2
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 259957
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 5242698
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License Number State | FL
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