MEDICARE: TARANEISHEA BROWN

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	376G00000X	Nursing Home Administrator

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

General Provider Information

NPI Number	:	1619628435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARANEISHEA BROWN

Provider Business Mailing Address
First Line	:	4725 HOLLY LAKE DR
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33463-5374
Country	:	US
Telephone Number	:	561-932-5231
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 NORTHPOINT PKWY STE 74
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-1812
Country	:	US
Telephone Number	:	561-619-0796
Fax Number	:

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

Provider Enumeration Date	:	01/13/2022
Last Update Date	:	01/13/2022

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Directions to “ TARANEISHEA BROWN ” Practice Location

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