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General NPI Number Information
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NPI Number | 1497459465
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Entity Type | Individual
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Provider Name | COURTNEY DISTEFANO-MANOLAS MSN, FNP-BC, PCCN
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Gender | Female
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Dates
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Enumeration Date | 03/27/2023
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 1425 S CONGRESS AVE
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City | DELRAY BEACH
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State | FL
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Zip | 33445-6384
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Country | US
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Telephone | 954-829-0391
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Fax |
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Provider Business Mailing Address
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Address Line | 8512 BLUE CYPRESS DR
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City | WELLINGTON
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State | FL
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Zip | 33467-6245
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Country | US
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Telephone | 929-235-6150
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2022092770
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11025901
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License Number State | FL
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