Healthcare Provider Details

I. General information

NPI: 1053280792
Provider Name (Legal Business Name): COURTNEY ALICIA WINN APRN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 MASSACHUSETTS AVE CROSSTOWN BLDG FL 7
BOSTON MA
02118
US

IV. Provider business mailing address

960 MASSACHUSETTS AVE STE 2
BOSTON MA
02118-2690
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-4841
  • Fax:
Mailing address:
  • Phone: 617-414-5405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2310828
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: