Healthcare Provider Details

I. General information

NPI: 1316580962
Provider Name (Legal Business Name): SERINA BOURASSA CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2019
Last Update Date: 04/10/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2868 ACTON RD
VESTAVIA AL
35243-2502
US

IV. Provider business mailing address

2868 ACTON RD
VESTAVIA AL
35243-2502
US

V. Phone/Fax

Practice location:
  • Phone: 205-332-3160
  • Fax: 866-702-0880
Mailing address:
  • Phone: 205-332-3160
  • Fax: 866-702-0880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number1-141732
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-141732
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: