Provider Demographics
NPI:1881631109
Name:BROOKS, EARL (CRNA, ARNP)
Entity Type:Individual
Prefix:MR
First Name:EARL
Middle Name:
Last Name:BROOKS
Suffix:
Gender:M
Credentials:CRNA, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3411 CHERRY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-5641
Mailing Address - Country:US
Mailing Address - Phone:850-248-9770
Mailing Address - Fax:850-248-9770
Practice Address - Street 1:1600 JENKS AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4644
Practice Address - Country:US
Practice Address - Phone:850-763-6666
Practice Address - Fax:850-769-6665
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9179236367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAN 0889Medicare UPIN