Healthcare Provider Details

I. General information

NPI: 1962835348
Provider Name (Legal Business Name): RANESSA LAUREN ACOSTA CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RANESSA LAUREN ACOSTA

II. Dates (important events)

Enumeration Date: 08/20/2013
Last Update Date: 06/07/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 AL HIGHWAY 157 STE C
CULLMAN AL
35058-1862
US

IV. Provider business mailing address

1935 AL HIGHWAY 157 STE C
CULLMAN AL
35058-1862
US

V. Phone/Fax

Practice location:
  • Phone: 256-297-3030
  • Fax: 256-297-3301
Mailing address:
  • Phone: 256-297-3030
  • Fax: 256-297-3301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1-191742
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: