Provider Demographics
NPI:1689110173
Name:CONNELL, COURTNEY (AP)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:
Last Name:CONNELL
Suffix:
Gender:M
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 HILLS RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:NOKOMIS
Mailing Address - State:FL
Mailing Address - Zip Code:34275-1446
Mailing Address - Country:US
Mailing Address - Phone:941-525-8073
Mailing Address - Fax:
Practice Address - Street 1:1187 US HIGHWAY 41 BYP S
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-5540
Practice Address - Country:US
Practice Address - Phone:941-525-8073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3065171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist