Provider Demographics
NPI:1548985278
Name:BROWN, FLAVIA DESOUSA (AG-ACNP)
Entity type:Individual
Prefix:MRS
First Name:FLAVIA
Middle Name:DESOUSA
Last Name:BROWN
Suffix:
Gender:F
Credentials:AG-ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15109
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28408-5109
Mailing Address - Country:US
Mailing Address - Phone:910-392-2525
Mailing Address - Fax:910-392-2827
Practice Address - Street 1:1709 S 16TH ST SITE# A
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-2840
Practice Address - Country:US
Practice Address - Phone:910-452-8633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5016991363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner