MEDICARE: AMANDA CHEYENNE BROWN APRN

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	APRN11018293	FL

General Provider Information

NPI Number	:	1316680689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA CHEYENNE BROWN APRN

Provider Business Mailing Address
First Line	:	139 NW TAFT LN
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055-4937
Country	:	US
Telephone Number	:	386-438-3225
Fax Number	:

Provider Business Practice Location Address
First Line	:	139 NW TAFT LN
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055-4937
Country	:	US
Telephone Number	:	386-438-3225
Fax Number	:

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

Provider Enumeration Date	:	04/15/2022
Last Update Date	:	04/15/2022

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