Healthcare Provider Details

I. General information

NPI: 1760843981
Provider Name (Legal Business Name): TATIANNE RILEY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2016
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 SPRING HILL AVE
MOBILE AL
36607-1822
US

IV. Provider business mailing address

308 SAINT LOUIS ST APT 101
MOBILE AL
36602-2827
US

V. Phone/Fax

Practice location:
  • Phone: 251-459-3875
  • Fax: 251-287-8477
Mailing address:
  • Phone: 251-459-3875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAG0116012
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAG0116012
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: