Healthcare Provider Details

I. General information

NPI: 1699177709
Provider Name (Legal Business Name): ASHLEY HANNA CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY COSTA

II. Dates (important events)

Enumeration Date: 09/19/2014
Last Update Date: 09/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 ELMER J BISSELL RD
BIRMINGHAM AL
35243-2941
US

IV. Provider business mailing address

3764 CROSSHAVEN DR
VESTAVIA AL
35223-2833
US

V. Phone/Fax

Practice location:
  • Phone: 205-638-4823
  • Fax: 205-638-4994
Mailing address:
  • Phone: 850-687-3822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1-131612
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: