Provider Demographics
NPI:1194247452
Name:BROWN, THRAESE (ARNP-C)
Entity type:Individual
Prefix:MS
First Name:THRAESE
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11214 E DR MARTIN LUTHER KING JR BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33584-8359
Mailing Address - Country:US
Mailing Address - Phone:813-679-6592
Mailing Address - Fax:813-845-0420
Practice Address - Street 1:407 N PARSONS AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-4537
Practice Address - Country:US
Practice Address - Phone:813-681-5880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-08
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9355176363LP2300X
FLAPRN9355176363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022521000Medicaid