Provider Demographics
NPI:1801245550
Name:SUGLIA, COURTNEY E (PAC)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:E
Last Name:SUGLIA
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:E
Other - Last Name:VENTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:7 HOLLAND WAY FL 1
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-2997
Mailing Address - Country:US
Mailing Address - Phone:603-777-1000
Mailing Address - Fax:603-777-1001
Practice Address - Street 1:7 ALUMNI DR
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-2118
Practice Address - Country:US
Practice Address - Phone:603-777-1000
Practice Address - Fax:603-777-1001
Is Sole Proprietor?:No
Enumeration Date:2016-06-03
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1171363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3104503Medicaid