Provider Demographics
NPI:1851899785
Name:JOUVENAZ COUR, KATHLEEN D (CRNA)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:D
Last Name:JOUVENAZ COUR
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 1:27227 PULLEN AVE APT A26
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-5400
Mailing Address - Country:US
Mailing Address - Phone:352-207-0015
Mailing Address - Fax:
Practice Address - Street 1:27227 PULLEN AVE APT A26
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-5400
Practice Address - Country:US
Practice Address - Phone:352-207-0015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL116404367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered