Provider Demographics
NPI:1619693249
Name:BOBO, SERA (CRNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:SERA
Middle Name:
Last Name:BOBO
Suffix:
Gender:F
Credentials:CRNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 HIGHWAY 78 E STE 108
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-8968
Mailing Address - Country:US
Mailing Address - Phone:205-265-3076
Mailing Address - Fax:205-265-2235
Practice Address - Street 1:3600 HIGHWAY 78 E STE 108
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-8968
Practice Address - Country:US
Practice Address - Phone:205-265-3076
Practice Address - Fax:205-265-2235
Is Sole Proprietor?:No
Enumeration Date:2022-10-14
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALF08221310363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily