Provider Demographics
NPI:1174936967
Name:GURR, BRIAN KEITH (CRNA)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:KEITH
Last Name:GURR
Suffix:
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:10140 CENTURION PARKWAY NORTH
Mailing Address - Street 2:NEMOURS HOME OFFICE - 2ND FLOOR EAST
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256
Mailing Address - Country:US
Mailing Address - Phone:904-697-4127
Mailing Address - Fax:904-697-5102
Practice Address - Street 1:13535 NEMOURS PKWY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7402
Practice Address - Country:US
Practice Address - Phone:407-567-4000
Practice Address - Fax:407-567-5924
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-09
Last Update Date:2017-07-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL9294096367500000X
FLARNP9294096367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012809000Medicaid