Provider Demographics
NPI:1487651402
Name:EARWOOD, BRENT EDWARD (CRNA)
Entity Type:Individual
Prefix:MR
First Name:BRENT
Middle Name:EDWARD
Last Name:EARWOOD
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17C BRENTSHIRE SQUARE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2273
Mailing Address - Country:US
Mailing Address - Phone:731-664-1717
Mailing Address - Fax:731-664-7114
Practice Address - Street 1:17C BRENTSHIRE SQUARE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2273
Practice Address - Country:US
Practice Address - Phone:731-664-1717
Practice Address - Fax:731-664-7114
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN09716367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3622515Medicaid
TN3622511Medicaid