Healthcare Provider Details

I. General information

NPI: 1831529486
Provider Name (Legal Business Name): BRIAN MAURER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2013
Last Update Date: 01/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 GRANDE DR
PENSACOLA FL
32504-5935
US

IV. Provider business mailing address

4901 GRANDE DR
PENSACOLA FL
32504-5935
US

V. Phone/Fax

Practice location:
  • Phone: 850-477-7042
  • Fax: 850-474-9060
Mailing address:
  • Phone: 850-477-7042
  • Fax: 850-474-9060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9373861
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: