Healthcare Provider Details

I. General information

NPI: 1699760884
Provider Name (Legal Business Name): LAURA ALEXIS BRANNON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA LEE THOMAS CRNA

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 11/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 SAINT JOSEPH LN
LONDON KY
40741-8345
US

IV. Provider business mailing address

401 E ROBINSON ST UNIT 403
ORLANDO FL
32801-4331
US

V. Phone/Fax

Practice location:
  • Phone: 606-330-6000
  • Fax: 606-330-7825
Mailing address:
  • Phone: 407-394-5223
  • Fax: 866-645-4229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP 451472
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP 0024165709
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP 711364
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3000063
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: