MEDICARE: QUOWANDA LA'KECIA FORD 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	RN9241527	FL

General Provider Information

NPI Number	:	1629650957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QUOWANDA LA'KECIA FORD BROWN RN

Provider Business Mailing Address
First Line	:	723 NW 2ND ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33311-9007
Country	:	US
Telephone Number	:	954-809-4157
Fax Number	:

Provider Business Practice Location Address
First Line	:	723 NW 2ND ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33311-9007
Country	:	US
Telephone Number	:	954-809-4157
Fax Number	:

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

Provider Enumeration Date	:	04/26/2021
Last Update Date	:	04/26/2021

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