Healthcare Provider Details

I. General information

NPI: 1164312310
Provider Name (Legal Business Name): TONYA ERNSBERGER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2967 ROSS CLARK CIR
DOTHAN AL
36301-1119
US

IV. Provider business mailing address

617 LASHAE LN
TROY AL
36081-3848
US

V. Phone/Fax

Practice location:
  • Phone: 334-305-2085
  • Fax:
Mailing address:
  • Phone: 334-672-6808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-139750
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: