Individual provider Active NPI

Jaelyn Brown

  • Nurse Practitioner
  • Tampa, FL
National Provider Identifier
1609615830
Registry record updated May 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
11031046 Issued in FL
Practice address
4129 W Kennedy Blvd Ste 2
Tampa, FL 33609-2254
Phone
(813) 384-8872
NPI assigned
May 20, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 20, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X 11031046 FL
Gerontology Nurse Practitioner 363LG0600X 11031046 FL
Nurse Practitioner 363L00000X 11031046 FL Primary

Addresses

Primary practice location

4129 W Kennedy Blvd Ste 2
Tampa, FL 33609-2254

Mailing address

4129 W Kennedy Blvd Ste 2
Tampa, FL 33609-2254
Phone (813) 384-8872

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240912001474 FL Practitioner - Nurse Practitioner 9133669542 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gulf to Bay Infectious Disease Consultants PLLCGroup PAC ID 6305169160, 2 clinicians

Practice addresses (Care Compare)

4129 W Kennedy Blvd
Suite 2
Tampa, FL 33609-2254
Phone (813) 541-1466

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
11031046FLMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Gulf to Bay Infectious Disease Consultants PLLC CurrentSince Aug 1, 2024 Accepting new patients

Locations

4129 W Kennedy Blvd
Ste 2
Tampa, FL 33609
Phone (813) 384-8872

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1716163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716163200000",
    "number": "1609615830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4129 W KENNEDY BLVD STE 2",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336092254",
            "telephone_number": "813-384-8872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4129 W KENNEDY BLVD STE 2",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336092254",
            "telephone_number": "813-384-8872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN",
        "first_name": "JAELYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-05-20",
        "last_updated": "2024-05-20",
        "certification_date": "2024-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "FL",
            "license": "11031046",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "FL",
            "license": "11031046",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "11031046",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.