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NPI Code Detail

MEDICARE: DAVONNA MARIE NICHOLS-BROWN

MEDICARE: DAVONNA MARIE NICHOLS-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
11041C0700XClinical Social WorkerSW25253FL
2101YM0800XMental Health CounselorSW25253FL

General Provider Information

NPI Number : 1649156555
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVONNA MARIE NICHOLS-BROWN
Provider Business Mailing Address
First Line : 5235 ARIVA DR APT 204
Second Line :
City : LAKELAND
State : FL
Zip : 33812-4445
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 126 LITHIA PINECREST RD STE 102
Second Line :
City : BRANDON
State : FL
Zip : 33511-5347
Country : US
Telephone Number : 863-535-6414
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2025
Last Update Date : 01/27/2026

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Directions to “ DAVONNA MARIE NICHOLS-BROWN ” Practice Location

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