Provider Demographics
NPI:1568777381
Name:BLACK, DJUANA GAIL (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:DJUANA
Middle Name:GAIL
Last Name:BLACK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 RUBY TYLER PKWY
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-2958
Mailing Address - Country:US
Mailing Address - Phone:205-759-7246
Mailing Address - Fax:205-759-7348
Practice Address - Street 1:1050 RUBY TYLER PKWY
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-2958
Practice Address - Country:US
Practice Address - Phone:205-759-7246
Practice Address - Fax:205-759-7348
Is Sole Proprietor?:No
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-069323363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily