Provider Demographics
NPI:1760792493
Name:CHUMBLEY, COURTNEY B (APRN)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:B
Last Name:CHUMBLEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-6860
Mailing Address - Fax:239-343-5179
Practice Address - Street 1:9981 S HEALTHPARK DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3618
Practice Address - Country:US
Practice Address - Phone:239-343-6860
Practice Address - Fax:239-343-6162
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9193559363LF0000X
FLARNP9193559363LF0000X
TX150540363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9193559OtherFL LICENSE
TX150540OtherTEMP TX RN
FL110891200Medicaid