Healthcare Provider Details

I. General information

NPI: 1407127368
Provider Name (Legal Business Name): COURTNEY W COPELAND CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY WADE CRNA

II. Dates (important events)

Enumeration Date: 01/24/2012
Last Update Date: 10/05/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 N DAVIS HWY
PENSACOLA FL
32503-2337
US

IV. Provider business mailing address

4600 N DAVIS HWY
PENSACOLA FL
32503-2337
US

V. Phone/Fax

Practice location:
  • Phone: 334-444-4599
  • Fax:
Mailing address:
  • Phone: 334-444-4599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-109025
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9356351
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: