MEDICARE: ANGEL CAMERON COURTNEY 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
1	367500000X	Certified Registered Nurse Anesthetist	9194759	FL
2	367500000X	Certified Registered Nurse Anesthetist	1-095484	AL
3	367500000X	Certified Registered Nurse Anesthetist	0094976	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00267635	OTHER		MEDICARE RAILROAD #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ARNP9194759	OTHER	FL	FL STATE LIC
2	G3809	OTHER	FL	FL BCBS #
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760537211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGEL CAMERON COURTNEY CRNA

Provider Business Mailing Address
First Line	:	30862 PINE CT
Second Line	:
City	:	SPANISH FORT
State	:	AL
Zip	:	36527-8668
Country	:	US
Telephone Number	:	407-973-0769
Fax Number	:

Provider Business Practice Location Address
First Line	:	30862 PINE CT
Second Line	:
City	:	SPANISH FORT
State	:	AL
Zip	:	36527-8668
Country	:	US
Telephone Number	:	407-973-0769
Fax Number	:

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	02/05/2017

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Directions to “ ANGEL CAMERON COURTNEY CRNA” Practice Location

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