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General NPI Number Information
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NPI Number | 1881238285
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Entity Type | Individual
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Provider Name | CHARLESETTA NICOLE BROWN APRN
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Gender | Female
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Dates
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Enumeration Date | 10/30/2019
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Last Update Date | 07/30/2024
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Provider Practice Location Address
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Address Line | 1699 S 14TH ST STE 10
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-1964
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Country | US
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Telephone | 904-450-6640
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Fax |
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Provider Business Mailing Address
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Address Line | 5791 UNIVERSITY CLUB BLVD N UNIT 309
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City | JACKSONVILLE
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State | FL
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Zip | 32277-9407
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Country | US
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Telephone | 904-521-2115
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 208444
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 208444
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 208444
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License Number State | LA
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11002310
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License Number State | FL
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