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General NPI Number Information
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NPI Number | 1134482029
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Entity Type | Individual
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Provider Name | BRIAN WAYNE CHURCH C.R.N.A.
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Gender | Male
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Dates
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Enumeration Date | 06/17/2012
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Last Update Date | 04/15/2026
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Provider Practice Location Address
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Address Line | 4035 SOUTHPOINT BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32216-0949
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Country | US
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Telephone | 904-507-6077
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Fax |
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Provider Business Mailing Address
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Address Line | 6489 SHADEWATER DR
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City | HILLIARD
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State | OH
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Zip | 43026-6248
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Country | US
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Telephone | 614-668-2771
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN.320250-COA1
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | COA.13948-NA
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | APRN11041227
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License Number State | FL
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