Healthcare Provider Details

I. General information

NPI: 1245845452
Provider Name (Legal Business Name): FAITH DANIELLE GOSA CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 10/01/2022
Certification Date: 10/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 6TH AVE S
BIRMINGHAM AL
35233-1802
US

IV. Provider business mailing address

2039 ADELSHIEM CIR SW
CULLMAN AL
35055-5577
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-7310
  • Fax:
Mailing address:
  • Phone: 205-717-9544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-176251
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-176251
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: