Provider Demographics
NPI:1750885174
Name:ROBERTSON, COURTNEY BROOKE (PA-C)
Entity type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:BROOKE
Last Name:ROBERTSON
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:816 INDEPENDENCE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-6010
Mailing Address - Country:US
Mailing Address - Phone:757-363-6800
Mailing Address - Fax:757-507-9023
Practice Address - Street 1:816 INDEPENDENCE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-6010
Practice Address - Country:US
Practice Address - Phone:757-363-6800
Practice Address - Fax:757-507-9023
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110006104363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical