Healthcare Provider Details

I. General information

NPI: 1497427322
Provider Name (Legal Business Name): COURTNEY WEBER AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2021
Last Update Date: 03/15/2024
Certification Date: 03/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1995 E OAKLAND PARK BLVD STE 310
FORT LAUDERDALE FL
33306-1138
US

IV. Provider business mailing address

PO BOX 936535
ATLANTA GA
31193-6535
US

V. Phone/Fax

Practice location:
  • Phone: 954-791-6146
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0121X
TaxonomyPlastic Surgery Registered Nurse
License Number9515295
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11029393
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN11029393
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: