Individual
CORTNEY D DOUGLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8203 NW 31ST AVE APT E29, GAINESVILLE, FL 32606
(352) 870-1268
Mailing address
8203 NW 31ST AVE APT E29, GAINESVILLE, FL 32606-6220
(352) 870-1268
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
—
—
372600000X
Adult Companion
008397800
FL
385HR2055X
Child Mental Illness Respite Care
008397800
FL
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
Primary
008397800
FL
385HR2065X
Child Physical Disabilities Respite Care
008397800
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008397800
—
FL
Enumeration date
12/29/2012
Last updated
06/10/2018
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