Provider Demographics
NPI:1942666391
Name:ROSTAS, RACHAEL BRIDGES (NP)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:BRIDGES
Last Name:ROSTAS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:LYNN
Other - Last Name:BRIDGES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3715 DAUPHIN ST
Mailing Address - Street 2:7A
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-1771
Mailing Address - Country:US
Mailing Address - Phone:251-460-4001
Mailing Address - Fax:
Practice Address - Street 1:3715 DAUPHIN ST
Practice Address - Street 2:7A
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1771
Practice Address - Country:US
Practice Address - Phone:251-460-4001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-14
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-137600363LP2300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL105I500268Medicare PIN