Healthcare Provider Details

I. General information

NPI: 1548979149
Provider Name (Legal Business Name): KRISTINA ALYESE BROWN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2022
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2985 DREW ST
CLEARWATER FL
33759-3012
US

IV. Provider business mailing address

19375 US HIGHWAY 19 N APT 409
CLEARWATER FL
33764-3321
US

V. Phone/Fax

Practice location:
  • Phone: 727-820-8200
  • Fax:
Mailing address:
  • Phone: 386-212-9976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number143502
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number9444084
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: