Provider Demographics
NPI:1114321031
Name:PLEDGER, COURTNEY LEIGH (PA-C)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LEIGH
Last Name:PLEDGER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:LEIGH
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-5651
Mailing Address - Fax:239-343-5652
Practice Address - Street 1:9981 S HEALTHPARK DR
Practice Address - Street 2:PICU
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908
Practice Address - Country:US
Practice Address - Phone:239-343-5651
Practice Address - Fax:239-343-5652
Is Sole Proprietor?:No
Enumeration Date:2014-10-21
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108327363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013790700Medicaid