Provider Demographics
NPI:1851330690
Name:BREWER, GINA M (CRNP)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:M
Last Name:BREWER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 COUNTY ROAD 37
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35634-3704
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3600 COUNTY ROAD 61
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35634-6640
Practice Address - Country:US
Practice Address - Phone:256-740-6674
Practice Address - Fax:256-740-6676
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1082739363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL891017080Medicaid
UT5765882OtherFIRST HEALTH
SCP00381660OtherMEDICARE RAILROAD
AL051539045OtherBLUE CROSS
ALQ38059Medicare UPIN
UT5765882OtherFIRST HEALTH