Healthcare Provider Details

I. General information

NPI: 1649833666
Provider Name (Legal Business Name): TABBATA CASTILLO RIVERS CRNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2019
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3810 WULFF RD E
SEMMES AL
36575-5256
US

IV. Provider business mailing address

PO BOX 2867
MOBILE AL
36652-2867
US

V. Phone/Fax

Practice location:
  • Phone: 251-445-0582
  • Fax:
Mailing address:
  • Phone: 251-690-8811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-143929
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: