Provider Demographics
NPI:1932851615
Name:WILLIFORD, BRIANNA M (CRNP)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:M
Last Name:WILLIFORD
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 1:1060 FAIRFAX PARK STE C
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2837
Mailing Address - Country:US
Mailing Address - Phone:057-527-3372
Mailing Address - Fax:
Practice Address - Street 1:1060 FAIRFAX PARK STE C
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2837
Practice Address - Country:US
Practice Address - Phone:205-752-7337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-144887363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics