Provider Demographics
NPI:1750927471
Name:VINYARD, COURTNEY GRACE (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:GRACE
Last Name:VINYARD
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-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 44008
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-3406
Mailing Address - Fax:904-244-3840
Practice Address - Street 1:15255 MAX LEGGETT PKWY STE 4900
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-7273
Practice Address - Country:US
Practice Address - Phone:904-244-3406
Practice Address - Fax:904-244-3840
Is Sole Proprietor?:No
Enumeration Date:2019-11-19
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61005365363LF0000X
FL11017495363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2158141Medicaid