Healthcare Provider Details

I. General information

NPI: 1245627322
Provider Name (Legal Business Name): DAVIDA SPANN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2015
Last Update Date: 04/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 CAHABA BEACH RD
BIRMINGHAM AL
35242-5225
US

IV. Provider business mailing address

2019 BELVEDERE CV
BIRMINGHAM AL
35242-6637
US

V. Phone/Fax

Practice location:
  • Phone: 205-421-2088
  • Fax: 205-982-7882
Mailing address:
  • Phone: 205-862-6240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-106106
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: