Provider Demographics
NPI:1801359096
Name:CORTES, STEPHANIE (RN)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:CORTES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CFY MEDICAL
Other - Middle Name:
Other - Last Name:LLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:1441 MANOTAK AVE APT 1811
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-1025
Mailing Address - Country:US
Mailing Address - Phone:787-948-1616
Mailing Address - Fax:
Practice Address - Street 1:1441 MANOTAK AVE APT 1811
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-1025
Practice Address - Country:US
Practice Address - Phone:787-948-1616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-13
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9509075363LA2200X, 163W00000X, 163WG0000X, 163WH0200X, 163WP0809X, 363LG0600X
PR025458163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology