Healthcare Provider Details

I. General information

NPI: 1679097075
Provider Name (Legal Business Name): ASHLEY ESTRADA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2017
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4525 SAINT STEPHENS RD
EIGHT MILE AL
36613-3508
US

IV. Provider business mailing address

4525 SAINT STEPHENS RD
EIGHT MILE AL
36613-3508
US

V. Phone/Fax

Practice location:
  • Phone: 251-452-0996
  • Fax: 251-257-1486
Mailing address:
  • Phone: 251-452-0996
  • Fax: 251-257-1486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-119651
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: