MEDICARE: BRENT JON PERSONS CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	APN.0992305-CRNA	CO

General Provider Information

NPI Number	:	1053391391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENT JON PERSONS CRNA

Provider Business Mailing Address
First Line	:	1330 QUAIL LAKE LOOP STE 220
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-4651
Country	:	US
Telephone Number	:	719-203-6111
Fax Number	:	877-247-9218

Provider Business Practice Location Address
First Line	:	1330 QUAIL LAKE LOOP STE 220
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-4651
Country	:	US
Telephone Number	:	719-203-6111
Fax Number	:	877-247-9218

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	01/28/2026

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