MEDICARE: MR. JOSEPH SIDNEY BROWN RN

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	163W00000X	Registered Nurse	RN1942952	FL

General Provider Information

NPI Number	:	1548414394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH SIDNEY BROWN RN

Provider Business Mailing Address
First Line	:	PO BOX 636
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32056-0636
Country	:	US
Telephone Number	:	386-752-8620
Fax Number	:

Provider Business Practice Location Address
First Line	:	1404 SOUTH MARION AVENUE #201
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32025-0636
Country	:	US
Telephone Number	:	386-752-8620
Fax Number	:

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

Provider Enumeration Date	:	11/06/2008
Last Update Date	:	11/06/2008

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