Healthcare Provider Details

I. General information

NPI: 1225819675
Provider Name (Legal Business Name): ASHLEY ALCALA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2023
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7591 PARADISE DR
GRAND BLANC MI
48439-8598
US

IV. Provider business mailing address

7591 PARADISE DR
GRAND BLANC MI
48439-8598
US

V. Phone/Fax

Practice location:
  • Phone: 810-938-0442
  • Fax:
Mailing address:
  • Phone: 810-938-0442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704340255
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: