Healthcare Provider Details

I. General information

NPI: 1558983924
Provider Name (Legal Business Name): BRIAN JOSEPH LONGORIA DNAP, CRNA, APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2020
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W MORENO ST
PENSACOLA FL
32501-2316
US

IV. Provider business mailing address

14 RIDGEBRIAR LN
NEWNAN GA
30265-6214
US

V. Phone/Fax

Practice location:
  • Phone: 850-437-8275
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11007019
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: