Provider Demographics
NPI:1447614151
Name:CHAMBLISS, COURTNEY DESHAE
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:DESHAE
Last Name:CHAMBLISS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 WOODLAND CIR # 1-104
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32967-2004
Mailing Address - Country:US
Mailing Address - Phone:772-453-3900
Mailing Address - Fax:
Practice Address - Street 1:1820 WOODLAND CIR # 1-104
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32967-2004
Practice Address - Country:US
Practice Address - Phone:772-453-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-08
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA304855376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide