Provider Demographics
NPI:1740735919
Name:LENNON, COURTNEY ALEXANDRA (PA-C)
Entity type:Individual
Prefix:MISS
First Name:COURTNEY
Middle Name:ALEXANDRA
Last Name:LENNON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7331 SW 139TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-3143
Mailing Address - Country:US
Mailing Address - Phone:305-773-8350
Mailing Address - Fax:
Practice Address - Street 1:4040 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3536
Practice Address - Country:US
Practice Address - Phone:954-322-7166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-17
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9109643363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical