Provider Demographics
NPI:1215961065
Name:BROWN, NIOMA M (ARNP-C)
Entity type:Individual
Prefix:
First Name:NIOMA
Middle Name:M
Last Name:BROWN
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
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Mailing Address - Street 1:4730 N HABANA AVE
Mailing Address - Street 2:STE 204
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-7148
Mailing Address - Country:US
Mailing Address - Phone:813-549-2134
Mailing Address - Fax:813-864-4436
Practice Address - Street 1:3622 MADACA LN
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2057
Practice Address - Country:US
Practice Address - Phone:813-961-1314
Practice Address - Fax:813-961-1315
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP1316622363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL303507700Medicaid
FLY7511OtherBLUE CROSS BLUE SHIELD
FLE0875WMedicare PIN
FL303507700Medicaid