Provider Demographics
NPI:1114530458
Name:SHEEHAN, COURTNEY A (ARNP)
Entity Type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:A
Last Name:SHEEHAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 KEVIN DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-2780
Mailing Address - Country:US
Mailing Address - Phone:904-449-5821
Mailing Address - Fax:
Practice Address - Street 1:510 KEVIN DR
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-2780
Practice Address - Country:US
Practice Address - Phone:904-449-5821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF06202083363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily