Provider Demographics
NPI:1063418200
Name:BROWN, FRANK A (CRNA)
Entity type:Individual
Prefix:MR
First Name:FRANK
Middle Name:A
Last Name:BROWN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 JACKSONS WAY SW
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36265-4305
Mailing Address - Country:US
Mailing Address - Phone:256-435-6999
Mailing Address - Fax:256-435-6999
Practice Address - Street 1:1210 JACKSONS WAY SW
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AL
Practice Address - Zip Code:36265-4305
Practice Address - Country:US
Practice Address - Phone:256-435-6999
Practice Address - Fax:256-435-6999
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS55340367500000X
GARN135363367500000X
AL1-085935367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA800742486BMedicaid
GA800742486GMedicaid
GA800742486KMedicaid
GA800742486KMedicaid
GA202I439590Medicare PIN
ALQ12517Medicare UPIN
GAP00603866Medicare PIN