Provider Demographics
NPI:1043635006
Name:MINGA, COURTNEY M (PA-C)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:M
Last Name:MINGA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:M
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4605 SAWMILL RD
Mailing Address - Street 2:
Mailing Address - City:UPPER ARLINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2246
Mailing Address - Country:US
Mailing Address - Phone:614-827-8700
Mailing Address - Fax:614-827-8701
Practice Address - Street 1:4605 SAWMILL RD
Practice Address - Street 2:
Practice Address - City:UPPER ARLINGTON
Practice Address - State:OH
Practice Address - Zip Code:43220-2246
Practice Address - Country:US
Practice Address - Phone:614-827-8700
Practice Address - Fax:614-827-8701
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-28
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-00398RX363A00000X
OH50.003984363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH50.003984OtherLICENSE