Healthcare Provider Details

I. General information

NPI: 1215313226
Provider Name (Legal Business Name): COURTNEY FLETCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY ZIOBRO

II. Dates (important events)

Enumeration Date: 08/03/2015
Last Update Date: 10/28/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 N HIGHLAND ST FL 32757
MOUNT DORA FL
32757-5764
US

IV. Provider business mailing address

13812 OLD DOCK RD
ORLANDO FL
32828-9508
US

V. Phone/Fax

Practice location:
  • Phone: 813-438-6796
  • Fax:
Mailing address:
  • Phone: 407-462-6735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-50750
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: