Provider Demographics
NPI:1982030391
Name:MILLER, COURTNEY LE ANN STEBLEIN (PA-C)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LE ANN STEBLEIN
Last Name:MILLER
Suffix:
Gender:F
Credentials:PA-C
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 741852
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-1852
Mailing Address - Country:US
Mailing Address - Phone:386-943-7100
Mailing Address - Fax:386-943-8900
Practice Address - Street 1:1070 NORTH STONE STREET
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720
Practice Address - Country:US
Practice Address - Phone:386-943-7100
Practice Address - Fax:386-943-8909
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPAT9107413363AM0700X
FLPA9107413363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH0744ZMedicare UPIN