Healthcare Provider Details

I. General information

NPI: 1730744012
Provider Name (Legal Business Name): ASHLY M. ACOSTA CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12701 PADGETT SWITCH RD
IRVINGTON AL
36544-4011
US

IV. Provider business mailing address

6801 AIRPORT BLVD
MOBILE AL
36608-3709
US

V. Phone/Fax

Practice location:
  • Phone: 251-824-2174
  • Fax:
Mailing address:
  • Phone: 251-266-3580
  • Fax: 251-266-3581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-078431
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: