MEDICARE: STACEY DEESE BROWN ARNP

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	363LF0000X	Family Nurse Practitioner	3279132	FL

General Provider Information

NPI Number	:	1578780508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY DEESE BROWN ARNP

Provider Business Mailing Address
First Line	:	371 MAGNOLIA DR
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33458-8379
Country	:	US
Telephone Number	:	561-575-1769
Fax Number	:

Provider Business Practice Location Address
First Line	:	11030 RCA CENTER DR
Second Line	:	SUITE 3015
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-4276
Country	:	US
Telephone Number	:	561-776-7041
Fax Number	:

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

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	11/20/2008

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