MEDICARE: JENNIFER N BROWN- LEWIS RD, LD/N

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	133V00000X	Registered Dietitian	ND5843	FL

General Provider Information

NPI Number	:	1942502257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER N BROWN- LEWIS RD, LD/N

Provider Business Mailing Address
First Line	:	4259 TANGLEWILDE DR S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-6438
Country	:	US
Telephone Number	:	904-571-2851
Fax Number	:	904-359-3816

Provider Business Practice Location Address
First Line	:	5322 N PEARL ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32208-5119
Country	:	US
Telephone Number	:	904-571-2851
Fax Number	:	904-359-3816

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

Provider Enumeration Date	:	11/19/2010
Last Update Date	:	02/28/2012

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