MEDICARE: MS. EBONY BROWN

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251E00000X	Home Health Agency
2	376K00000X	Nurse's Aide
3	261QD1600X	Developmental Disabilities Clinic/Center
4	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1073484671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EBONY BROWN

Provider Business Mailing Address
First Line	:	1100 KINGS RD UNIT 40123
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32203-7779
Country	:	US
Telephone Number	:	904-846-7575
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 KINGS RD UNIT 40123
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32203-7779
Country	:	US
Telephone Number	:	904-846-7575
Fax Number	:

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

Provider Enumeration Date	:	09/16/2025
Last Update Date	:	09/16/2025

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