Provider Demographics
NPI:1902324171
Name:BROWN, JESICA LEE
Entity Type:Individual
Prefix:
First Name:JESICA
Middle Name:LEE
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ARAGON AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-5300
Mailing Address - Country:US
Mailing Address - Phone:305-448-6166
Mailing Address - Fax:305-448-6150
Practice Address - Street 1:6 ARAGON AVENUE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5308
Practice Address - Country:US
Practice Address - Phone:305-448-6166
Practice Address - Fax:305-448-6150
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL070802400OtherCERTIFIED ATHLETIC TRAINER