Provider Demographics
NPI:1609336296
Name:DAVIS, COURTNEY LANE (FNP-C, AGACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:LANE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:FNP-C, AGACNP-BC
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:DARLENE
Other - Last Name:LANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C, AGACNP-BC
Mailing Address - Street 1:42 EGRET ST N
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32327-1411
Mailing Address - Country:US
Mailing Address - Phone:573-855-2887
Mailing Address - Fax:
Practice Address - Street 1:2382 CRAWFORDVILLE HWY STE C
Practice Address - Street 2:
Practice Address - City:CRAWFORDVILLE
Practice Address - State:FL
Practice Address - Zip Code:32327-1091
Practice Address - Country:US
Practice Address - Phone:850-926-6363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-21
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11002624363LA2100X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care