MEDICARE: REBECCA ANN BROWN NAVY IDC

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	1710I1002X	Independent Duty Corpsman

General Provider Information

NPI Number	:	1205146727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA ANN BROWN NAVY IDC

Provider Business Mailing Address
First Line	:	BLDG 938 BOX 44
Second Line	:	NAS JACKSONVILLE MSRON 10
City	:	JACKSONVILLE
State	:	FL
Zip	:	32065
Country	:	US
Telephone Number	:	678-863-7369
Fax Number	:	904-542-1782

Provider Business Practice Location Address
First Line	:	3092 LITCHFIELD DR
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32065
Country	:	US
Telephone Number	:	678-863-7369
Fax Number	:	904-542-1782

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

Provider Enumeration Date	:	10/18/2010
Last Update Date	:	10/18/2010

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