Healthcare Provider Details

I. General information

NPI: 1487039350
Provider Name (Legal Business Name): SARA DANIELLE PHILLIPS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARA DANIELLE BROKUS CRNP

II. Dates (important events)

Enumeration Date: 07/21/2015
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1808 7TH AVE S BDB 503
BIRMINGHAM AL
35233-1912
US

IV. Provider business mailing address

1808 7TH AVE S # BDB652
BIRMINGHAM AL
35233-1912
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-2006
  • Fax: 205-934-0024
Mailing address:
  • Phone: 205-934-2006
  • Fax: 205-934-0053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1-117943
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: