Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jackqulyn Brown

Individual provider Registered Nurse · NPI 1194591719

Jackqulyn Brown is a Nurse Practitioner in Southfield, Michigan. Qualified in 2023, 3 years ago. Licensed in Michigan.

Years since qualifying
3
Licensed in
MI
In the registry since
2023
Specialties on file
2
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Practice location Address checks out

20755 Greenfield Rd Ste 100
Southfield, MI 48075-5400
Phone: (248) 557-0507
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 4704342245 (MI)
Registered Nurse Taxonomy 163W00000X · Licence 4704342245 (MI)

Record details

NPI number1194591719
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedNovember 27, 2023
Last updated in NPPESNovember 27, 2023
Certification dateNovember 27, 2023
Mailing address20755 Greenfield Rd Ste 100, Southfield, MI 48075-5400

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Accepts Medicare assignment Not indicated

Other providers in Southfield