MEDICARE: TAMELA TANISHA BROWN FNP

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	363L00000X	Nurse Practitioner	F03260459	MI

General Provider Information

NPI Number	:	1194667451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMELA TANISHA BROWN FNP

Provider Business Mailing Address
First Line	:	28048 ABERDEEN ST
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48076-2916
Country	:	US
Telephone Number	:	313-566-3225
Fax Number	:

Provider Business Practice Location Address
First Line	:	28048 ABERDEEN ST
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48076-2916
Country	:	US
Telephone Number	:	313-566-3225
Fax Number	:

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

Provider Enumeration Date	:	04/07/2026
Last Update Date	:	04/07/2026

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