Provider Demographics
NPI:1760537211
Name:COURTNEY, ANGEL CAMERON (CRNA)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:CAMERON
Last Name:COURTNEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30862 PINE CT
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORT
Mailing Address - State:AL
Mailing Address - Zip Code:36527-8668
Mailing Address - Country:US
Mailing Address - Phone:407-973-0769
Mailing Address - Fax:
Practice Address - Street 1:30862 PINE CT
Practice Address - Street 2:
Practice Address - City:SPANISH FORT
Practice Address - State:AL
Practice Address - Zip Code:36527-8668
Practice Address - Country:US
Practice Address - Phone:407-973-0769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2017-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9194759367500000X
AL1-095484367500000X
OK0094976367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9194759OtherFL STATE LIC
FLG3809OtherFL BCBS #
P00267635OtherMEDICARE RAILROAD #
FLG3809ZMedicare ID - Type UnspecifiedMEDICARE #