Provider Demographics
NPI:1699760884
Name:BRANNON, LAURA ALEXIS (CRNA)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ALEXIS
Last Name:BRANNON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:LEE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:401 E ROBINSON ST
Mailing Address - Street 2:UNIT 403
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-4331
Mailing Address - Country:US
Mailing Address - Phone:407-394-5223
Mailing Address - Fax:866-645-4229
Practice Address - Street 1:1001 SAINT JOSEPH LN
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-8345
Practice Address - Country:US
Practice Address - Phone:606-330-6000
Practice Address - Fax:606-330-7825
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 451472367500000X
VAARNP 0024165709367500000X
TXARNP 711364367500000X
KY3000063367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305050900Medicaid
FL02157OtherBLUE SHIELD
FLG2157YMedicare ID - Type Unspecified
FL305050900Medicaid