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NPI Code Detail

MEDICARE: MS. TONYA M BROCK CRNA

MEDICARE: MS. TONYA M BROCK CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist2002016070MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1578526729
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TONYA M BROCK CRNA
Provider Business Mailing Address
First Line : 660 S EUCLID AVE
Second Line : C B 8054
City : SAINT LOUIS
State : MO
Zip : 63110-1010
Country : US
Telephone Number : 314-996-8378
Fax Number : 314-996-8910
Provider Business Practice Location Address
First Line : 12634 OLIVE BLVD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63141-6337
Country : US
Telephone Number : 314-996-8378
Fax Number : 314-996-8910
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2006
Last Update Date : 02/19/2026

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