Provider Demographics
NPI:1558341941
Name:COSGROVE, PATTI A (CRNA)
Entity Type:Individual
Prefix:
First Name:PATTI
Middle Name:A
Last Name:COSGROVE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:PATTI
Other - Middle Name:A
Other - Last Name:PERKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:2151 OLD ROCKY RIDGE RD
Mailing Address - Street 2:SUITE #106
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35216-7235
Mailing Address - Country:US
Mailing Address - Phone:205-989-1080
Mailing Address - Fax:205-989-1087
Practice Address - Street 1:2720 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-3408
Practice Address - Country:US
Practice Address - Phone:205-933-7246
Practice Address - Fax:205-933-7209
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-052630367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000078333Medicaid
S06638Medicare UPIN
AL000078333Medicaid