Provider Demographics
NPI:1053381160
Name:PIERCE, THOMAS HAROLD (CRNA)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:HAROLD
Last Name:PIERCE
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 1:2134 NEBULA WAY UNIT 101
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-9083
Mailing Address - Country:US
Mailing Address - Phone:256-990-5466
Mailing Address - Fax:
Practice Address - Street 1:2134 NEBULA WAY UNIT 101
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-9083
Practice Address - Country:US
Practice Address - Phone:256-990-5466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK410367500000X
AL1-040035367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051526352Medicaid
AL51526352OtherBCBS OF AL PIN
AL000050038Medicaid
ALR80935Medicare UPIN
AL000050038Medicaid
AL051550038Medicare ID - Type Unspecified