Individual
KOURTNEY FALLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
17 DAVIS BLVD, 100, TAMPA, FL 33606-3475
(813) 259-8700
Mailing address
PO BOX 917770, ORLANDO, FL 32891-0001
(813) 974-2201
(813) 974-2812
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
ARNP9296288
FL
363LP2300X
Primary Care Nurse Practitioner
ARNP9296288
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
015999900
—
FL
01
—
AATWE
BLUE CROSS BLUE SHIELD
FL
Enumeration date
10/20/2015
Last updated
10/27/2020
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