Provider Demographics
NPI:1770635922
Name:BRUMBAUGH, LAURA R (CRNA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:R
Last Name:BRUMBAUGH
Suffix:
Gender:F
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:PO BOX 413012
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34101-3012
Mailing Address - Country:US
Mailing Address - Phone:239-261-1158
Mailing Address - Fax:239-261-4232
Practice Address - Street 1:4949 TAMIAMI TRL N
Practice Address - Street 2:SUITRE 206
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-3027
Practice Address - Country:US
Practice Address - Phone:239-261-1158
Practice Address - Fax:239-261-4232
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9217622367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG4153OtherBCBS PROVIDER
FL308126500Medicaid
FL308126500Medicaid