Healthcare Provider Details

I. General information

NPI: 1730195835
Provider Name (Legal Business Name): GARY BROWN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 DUNDEE RD
WINTER HAVEN FL
33884-1166
US

IV. Provider business mailing address

PO BOX 106002
ATLANTA GA
30348-6002
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-4848
  • Fax: 352-732-6282
Mailing address:
  • Phone: 352-867-8898
  • Fax: 352-732-6282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9227820
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: