Individual
MRS. COURTNEY ANN PROVINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
3400 CIVIC CENTER BLVD, 2 SOUTH, PHILADELPHIA, PA 19104
(215) 615-0718
(215) 349-8309
Mailing address
5709 SHETLAND CT, BENSALEM, PA 19020
(267) 760-1174
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
SP021617
PA
363LF0000X
Family Nurse Practitioner
SP014616
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1029886820001
—
PA
01
—
30218673
KEYSTONE FIRST
PA
01
—
3120472
HIGHMARK BLUE SHIELD
PA
01
—
4324295
CIGNA PA
PA
01
—
5764869
AETNA
PA
01
—
P01435312
RAILROAD MEDICARE
PA
Enumeration date
12/08/2014
Last updated
11/15/2021
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