Healthcare Provider Details

I. General information

NPI: 1124858451
Provider Name (Legal Business Name): COURTNEY ELIZABETH FLYNN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2024
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 YORK AVE APT 26G
NEW YORK NY
10021-4868
US

IV. Provider business mailing address

1320 YORK AVE APT 26G
NEW YORK NY
10021-4868
US

V. Phone/Fax

Practice location:
  • Phone: 203-535-8474
  • Fax:
Mailing address:
  • Phone: 203-535-8474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number354917
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: