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NPI Code Detail

MEDICARE: MR. EARL BROOKS CRNA, ARNP

MEDICARE: MR. EARL BROOKS CRNA, ARNP
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
1367500000XCertified Registered Nurse AnesthetistARNP 9179236FL

General Provider Information

NPI Number : 1881631109
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. EARL BROOKS CRNA, ARNP
Provider Business Mailing Address
First Line : 3411 CHERRY RIDGE RD
Second Line :
City : LYNN HAVEN
State : FL
Zip : 32444-5641
Country : US
Telephone Number : 850-248-9770
Fax Number : 850-248-9770
Provider Business Practice Location Address
First Line : 1600 JENKS AVE
Second Line :
City : PANAMA CITY
State : FL
Zip : 32405-4644
Country : US
Telephone Number : 850-763-6666
Fax Number : 850-769-6665
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2006
Last Update Date : 07/08/2007

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