Provider Demographics
NPI:1699894378
Name:EATON, BRENT (NP-C, CRNFA, LSA)
Entity type:Individual
Prefix:MR
First Name:BRENT
Middle Name:
Last Name:EATON
Suffix:
Gender:M
Credentials:NP-C, CRNFA, LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 IRONWOOD PASS DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-3781
Mailing Address - Country:US
Mailing Address - Phone:832-600-5144
Mailing Address - Fax:713-903-7910
Practice Address - Street 1:2106 IRONWOOD PASS DR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-3781
Practice Address - Country:US
Practice Address - Phone:832-600-5144
Practice Address - Fax:713-903-7910
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2024-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00623246ZC0007X
TXF0510035363L00000X
TXAP119124363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8010NBOtherBCBS
TX600804OtherTEXAS MEDICAL BOARD