Provider Demographics
NPI:1215656061
Name:FACEY-BROWN, JANICE
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:FACEY-BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8090 NW 12TH ST # 11A
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-3081
Mailing Address - Country:US
Mailing Address - Phone:954-336-3287
Mailing Address - Fax:
Practice Address - Street 1:6 N DORCAS ST
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-1737
Practice Address - Country:US
Practice Address - Phone:717-953-9571
Practice Address - Fax:717-953-9576
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP027344363LP0808X
FL11021521363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health