Provider Demographics
NPI:1205146727
Name:BROWN, REBECCA ANN (NAVY IDC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:BROWN
Suffix:
Gender:F
Credentials:NAVY IDC
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:ANN
Other - Last Name:GADDIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NAVY IDC
Mailing Address - Street 1:BLDG 938 BOX 44
Mailing Address - Street 2:NAS JACKSONVILLE MSRON 10
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32065
Mailing Address - Country:US
Mailing Address - Phone:678-863-7369
Mailing Address - Fax:904-542-1782
Practice Address - Street 1:3092 LITCHFIELD DR
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065
Practice Address - Country:US
Practice Address - Phone:678-863-7369
Practice Address - Fax:904-542-1782
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman