MEDICARE: MRS. JENNIFER FIELD BROWN PHM-CNS/ NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist	0015000720	VA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0024168259	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	O87933	OTHER	VA	OPTIMA/ SENTARA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	437209	OTHER	VA	ANTHEM

General Provider Information

NPI Number	:	1063405686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER FIELD BROWN PHM-CNS/ NP

Provider Business Mailing Address
First Line	:	1072 LASKIN RD
Second Line	:	SUITE 104
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-6364
Country	:	US
Telephone Number	:	757-648-8605
Fax Number	:	757-648-1363

Provider Business Practice Location Address
First Line	:	1072 LASKIN RD
Second Line	:	SUITE 104
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-6364
Country	:	US
Telephone Number	:	757-648-8605
Fax Number	:	757-648-1363

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	12/27/2016

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