Healthcare Provider Details

I. General information

NPI: 1023123361
Provider Name (Legal Business Name): DEBORAH BRZYCKI CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 NEW PINERY RD
PORTAGE WI
53901-9240
US

IV. Provider business mailing address

4048 EVANS AVE STE 303
FORT MYERS FL
33901-9390
US

V. Phone/Fax

Practice location:
  • Phone: 262-416-8317
  • Fax:
Mailing address:
  • Phone: 239-332-5344
  • Fax: 239-332-7246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number128812
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9245661
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209025673
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: