Basic Information
| Provider Information | |||||||||
| NPI: | 1194826602 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | NATHAN | ||||||||
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| Credential: | P.A.-C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6405 N FEDERAL HWY | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | FT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333081412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547722411 | ||||||||
| FaxNumber: | 9547723766 | ||||||||
| Practice Location | |||||||||
| Address1: | 6405 N FEDERAL HWY | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | FT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333081412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547722411 | ||||||||
| FaxNumber: | 9547723766 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2006 | ||||||||
| LastUpdateDate: | 09/08/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA9103878 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | PA9103878 | 01 | FL | PHYSICIAN ASSISTANT LIC | OTHER |