Healthcare Provider Details

I. General information

NPI: 1942570619
Provider Name (Legal Business Name): COURTNEY NOVELLO CCP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 S CONGRESS AVE
ATLANTIS FL
33462-1149
US

IV. Provider business mailing address

3100 W END AVE STE 800
NASHVILLE TN
37203-1378
US

V. Phone/Fax

Practice location:
  • Phone: 561-965-7300
  • Fax: 888-468-6511
Mailing address:
  • Phone: 615-345-5400
  • Fax: 888-468-6511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code242T00000X
TaxonomyPerfusionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: