Provider Demographics
NPI:1134534399
Name:BLOCKER, COURTNEY VANN (FNP-C)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:VANN
Last Name:BLOCKER
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:VANN
Other - Last Name:BOKSAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3158 FREEDOM DR STE 3102
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-0014
Mailing Address - Country:US
Mailing Address - Phone:704-971-7099
Mailing Address - Fax:704-971-0035
Practice Address - Street 1:10710 SIKES PL STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-8194
Practice Address - Country:US
Practice Address - Phone:704-248-5101
Practice Address - Fax:704-248-5120
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN621420163WD0400X
NC5017719363L00000X, 363LF0000X
PASP018799363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner