Provider Demographics
NPI:1073102216
Name:SCOTT, COURTNEY ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ANN
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 NE 12TH ST APT 4
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33444-4057
Mailing Address - Country:US
Mailing Address - Phone:772-233-0003
Mailing Address - Fax:
Practice Address - Street 1:599 FARMINGTON AVE FL 2
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2381
Practice Address - Country:US
Practice Address - Phone:860-837-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-12
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6182363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant