Provider Demographics
NPI:1861419855
Name:BREWER, JAYLIN N (CRNA)
Entity type:Individual
Prefix:
First Name:JAYLIN
Middle Name:N
Last Name:BREWER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JAYLIN
Other - Middle Name:N
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:2929 E THOMAS RD
Mailing Address - Street 2:PHOENIX
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-8034
Mailing Address - Country:US
Mailing Address - Phone:480-248-7658
Mailing Address - Fax:480-248-7658
Practice Address - Street 1:2929 E THOMAS RD
Practice Address - Street 2:PHOENIX
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-8034
Practice Address - Country:US
Practice Address - Phone:480-248-7658
Practice Address - Fax:480-248-7658
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCRNA0570367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ345903Medicaid
N/AMedicare UPIN
AZ345903Medicaid