Provider Demographics
NPI:1699060533
Name:BROWN, COMELIA J (RN)
Entity type:Individual
Prefix:
First Name:COMELIA
Middle Name:J
Last Name:BROWN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 US 1 SOUTH
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5788
Mailing Address - Country:US
Mailing Address - Phone:904-825-5055
Mailing Address - Fax:904-825-6875
Practice Address - Street 1:1955 US 1 S
Practice Address - Street 2:SUITE 100
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5788
Practice Address - Country:US
Practice Address - Phone:904-825-5055
Practice Address - Fax:904-825-6875
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9293195163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse