Provider Demographics
NPI:1114774999
Name:BROWN, JOANNA GRACE (LPN)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:GRACE
Last Name:BROWN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7311 STATE HIGHWAY 2 W
Mailing Address - Street 2:
Mailing Address - City:DEFUNIAK SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32433-5890
Mailing Address - Country:US
Mailing Address - Phone:850-240-2012
Mailing Address - Fax:
Practice Address - Street 1:7311 STATE HIGHWAY 2 W
Practice Address - Street 2:
Practice Address - City:DEFUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32433-5890
Practice Address - Country:US
Practice Address - Phone:850-240-2012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5231663164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse