Provider Demographics
NPI:1255382917
Name:BROOKS, TERRY ANN (CRNA)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:ANN
Last Name:BROOKS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:TERRY
Other - Middle Name:LARSON
Other - Last Name:HUDGINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:3109 FRENCH HILL DR
Mailing Address - Street 2:
Mailing Address - City:POWHATAN
Mailing Address - State:VA
Mailing Address - Zip Code:23139-4527
Mailing Address - Country:US
Mailing Address - Phone:804-397-0156
Mailing Address - Fax:
Practice Address - Street 1:3109 FRENCH HILL DR
Practice Address - Street 2:
Practice Address - City:POWHATAN
Practice Address - State:VA
Practice Address - Zip Code:23139-4527
Practice Address - Country:US
Practice Address - Phone:804-397-0156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024094652367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010192544Medicaid
VAP00239516Medicare ID - Type UnspecifiedRAILROAD MEDICARE NUMBER
VA008601C37Medicare ID - Type Unspecified