Provider Demographics
NPI:1598043390
Name:TITUS, COURTNEY CALI (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:CALI
Last Name:TITUS
Suffix:
Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:601 5TH ST S
Mailing Address - Street 2:ALL CHILDREN'S SPECIALTY PHYSICIANS OCC, SUITE 501
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4804
Mailing Address - Country:US
Mailing Address - Phone:727-767-8480
Mailing Address - Fax:727-767-8420
Practice Address - Street 1:601 5TH ST S
Practice Address - Street 2:ALL CHILDREN'S SPECIALTY PHYSICIANS OCC, SUITE 501
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4804
Practice Address - Country:US
Practice Address - Phone:727-767-8480
Practice Address - Fax:727-767-8420
Is Sole Proprietor?:No
Enumeration Date:2011-07-27
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9106035363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003900700Medicaid