Provider Demographics
NPI:1316680689
Name:BROWN, AMANDA CHEYENNE (APRN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:CHEYENNE
Last Name:BROWN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 NW TAFT LN
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-4937
Mailing Address - Country:US
Mailing Address - Phone:386-438-3225
Mailing Address - Fax:
Practice Address - Street 1:139 NW TAFT LN
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-4937
Practice Address - Country:US
Practice Address - Phone:386-438-3225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-15
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11018293363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner