MEDICARE: NIOMA M BROWN ARNP-C

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	ARNP1316622	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	Y7511	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1215961065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIOMA M BROWN ARNP-C

Provider Business Mailing Address
First Line	:	4730 N HABANA AVE
Second Line	:	STE 204
City	:	TAMPA
State	:	FL
Zip	:	33614-7148
Country	:	US
Telephone Number	:	813-549-2134
Fax Number	:	813-864-4436

Provider Business Practice Location Address
First Line	:	3622 MADACA LN
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-2057
Country	:	US
Telephone Number	:	813-961-1314
Fax Number	:	813-961-1315

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	07/21/2022

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