MEDICARE: COURTNEY NICOLE SEGURA NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	0000	FL

General Provider Information

NPI Number	:	1245829878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY NICOLE SEGURA NP

Provider Business Mailing Address
First Line	:	PO BOX 948237
Second Line	:
City	:	MAITLAND
State	:	FL
Zip	:	32794-8237
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 N LAKEMONT AVE STE 2300
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-3208
Country	:	US
Telephone Number	:	321-444-6560
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2021
Last Update Date	:	01/18/2021

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