Provider Demographics
NPI:1093012163
Name:MIDDLEBROOKS, REGINALD (CRNA)
Entity Type:Individual
Prefix:DR
First Name:REGINALD
Middle Name:
Last Name:MIDDLEBROOKS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:MR
Other - First Name:REGGIE
Other - Middle Name:
Other - Last Name:MIDDLEBROOKS
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:DNP
Mailing Address - Street 1:3100 SPRING FOREST RD STE 130
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-2880
Mailing Address - Country:US
Mailing Address - Phone:888-280-9533
Mailing Address - Fax:919-873-9821
Practice Address - Street 1:620 JOHN PAUL JONES CIR
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23708-2111
Practice Address - Country:US
Practice Address - Phone:757-953-3238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-24
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL085238367500000X
VA0024172635367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered