Healthcare Provider Details

I. General information

NPI: 1366908287
Provider Name (Legal Business Name): MRS. TERRASEETA CRAIG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TERRASEETA CRAIG CRNP

II. Dates (important events)

Enumeration Date: 02/15/2019
Last Update Date: 06/23/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28740 US HIGHWAY 98 STE 9
DAPHNE AL
36526-7207
US

IV. Provider business mailing address

1528 DEERWOOD DR E
MOBILE AL
36618-3073
US

V. Phone/Fax

Practice location:
  • Phone: 251-270-2911
  • Fax:
Mailing address:
  • Phone: 251-422-1105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-094492
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11001979
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number1-094492
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: