Provider Demographics
NPI:1295080414
Name:BROWN, CHRISTA NOEL (NNP)
Entity type:Individual
Prefix:
First Name:CHRISTA
Middle Name:NOEL
Last Name:BROWN
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:CHRISTA
Other - Middle Name:NOEL
Other - Last Name:HERRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:142 BRYCE RYAN CIR
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31548-7812
Mailing Address - Country:US
Mailing Address - Phone:912-409-7583
Mailing Address - Fax:
Practice Address - Street 1:142 BRYCE RYAN CIR
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548-7812
Practice Address - Country:US
Practice Address - Phone:912-409-7583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-14
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9315171363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003127937AMedicaid
FL006609600Medicaid
FLGO138ZMedicare PIN