Provider Demographics
NPI:1790444776
Name:BREWER, ANGELA M (CRNA)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:BREWER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:A
Other - Last Name:MAZZITELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1808 CREEK BEND DR
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:TX
Mailing Address - Zip Code:76208-5180
Mailing Address - Country:US
Mailing Address - Phone:940-808-8626
Mailing Address - Fax:
Practice Address - Street 1:1575 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4901
Practice Address - Country:US
Practice Address - Phone:817-702-3431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-16
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX133949367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered