Provider Demographics
NPI:1235261595
Name:BROWN, AMANDA RENA (CRNA)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:RENA
Last Name:BROWN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:RENA
Other - Last Name:WITHERSPOON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:653 W. 23RD
Mailing Address - Street 2:#284
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404
Mailing Address - Country:US
Mailing Address - Phone:850-896-8799
Mailing Address - Fax:
Practice Address - Street 1:653 W. 23RD
Practice Address - Street 2:#284
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405
Practice Address - Country:US
Practice Address - Phone:850-896-8799
Practice Address - Fax:850-896-8799
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN149514367500000X
SC4386367500000X
FL9216040367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000503500Medicaid
FLBH925ZOtherMEDICARE
FL000503500Medicaid
FLBH925ZOtherMEDICARE