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NPI Code Detail

MEDICARE: COURTNEY YVETTE LICUL CRNA

MEDICARE:   COURTNEY YVETTE LICUL  CRNA
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
1163W00000XRegistered Nurse291583TN

General Provider Information

NPI Number : 1568329787
Entity Type Code : Individual
Provider Name (Legal Business Name) : COURTNEY YVETTE LICUL CRNA
Provider Business Mailing Address
First Line : 12222 MERIT DR STE 600
Second Line :
City : DALLAS
State : TX
Zip : 75251-3294
Country : US
Telephone Number : 972-663-8523
Fax Number : 972-663-8329
Provider Business Practice Location Address
First Line : 110 29TH AVE N STE 202
Second Line :
City : NASHVILLE
State : TN
Zip : 37203-1448
Country : US
Telephone Number : 615-327-4304
Fax Number : 615-327-7940
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2026
Last Update Date : 01/08/2026

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Directions to “ COURTNEY YVETTE LICUL CRNA” Practice Location

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