MEDICARE: LAURA ALEXIS BRANNON 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	ARNP 451472	FL
2	367500000X	Certified Registered Nurse Anesthetist	ARNP 0024165709	VA
3	367500000X	Certified Registered Nurse Anesthetist	ARNP 711364	TX
4	367500000X	Certified Registered Nurse Anesthetist	3000063	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	02157	OTHER	FL	BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699760884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA ALEXIS BRANNON CRNA

Provider Business Mailing Address
First Line	:	401 E ROBINSON ST
Second Line	:	UNIT 403
City	:	ORLANDO
State	:	FL
Zip	:	32801-4331
Country	:	US
Telephone Number	:	407-394-5223
Fax Number	:	866-645-4229

Provider Business Practice Location Address
First Line	:	1001 SAINT JOSEPH LN
Second Line	:
City	:	LONDON
State	:	KY
Zip	:	40741-8345
Country	:	US
Telephone Number	:	606-330-6000
Fax Number	:	606-330-7825

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

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	11/01/2012

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Directions to “ LAURA ALEXIS BRANNON CRNA” Practice Location

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