Healthcare Provider Details

I. General information

NPI: 1003769167
Provider Name (Legal Business Name): COURTNEY ANN WIGHT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 HARDEN BLVD
LAKELAND FL
33803-1826
US

IV. Provider business mailing address

PO BOX 25201
TAMPA FL
33622-5201
US

V. Phone/Fax

Practice location:
  • Phone: 813-701-5804
  • Fax: 813-291-7615
Mailing address:
  • Phone: 727-823-2188
  • Fax: 727-828-0723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11045550
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: