MEDICARE: TIESHA LATOYA BROWN LPN

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	164W00000X	Licensed Practical Nurse	PN5150962	FL

General Provider Information

NPI Number	:	1720251655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIESHA LATOYA BROWN LPN

Provider Business Mailing Address
First Line	:	1800 EDGEWOOD AVE W
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32208-8000
Country	:	US
Telephone Number	:	904-924-7756
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 EDGEWOOD AVE W
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32208-8000
Country	:	US
Telephone Number	:	904-924-7756
Fax Number	:

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

Provider Enumeration Date	:	04/11/2008
Last Update Date	:	04/11/2008

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