Healthcare Provider Details

I. General information

NPI: 1831663616
Provider Name (Legal Business Name): COURTNEY NICOLE WEST DOULA, LPN, CBE, CLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2019
Last Update Date: 09/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2335 22ND AVE S # 4
SAINT PETERSBURG FL
33712
US

IV. Provider business mailing address

2335 22ND AVE S
ST PETERSBURG FL
33712-3019
US

V. Phone/Fax

Practice location:
  • Phone: 727-231-4670
  • Fax:
Mailing address:
  • Phone: 727-231-4670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: