Healthcare Provider Details

I. General information

NPI: 1487960373
Provider Name (Legal Business Name): ANGELA H COBB CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2010
Last Update Date: 01/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MOBILE INFIRMARY CIR
MOBILE AL
36607-3513
US

IV. Provider business mailing address

PO BOX 10583
BIRMINGHAM AL
35202-0583
US

V. Phone/Fax

Practice location:
  • Phone: 251-435-2646
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-112833
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3211
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: