1154552503 NPI number — MRS. COURTNEY BROOKE DAVENPORT MSW

Table of content: MRS. COURTNEY BROOKE DAVENPORT MSW (NPI 1154552503)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154552503 NPI number — MRS. COURTNEY BROOKE DAVENPORT MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVENPORT
Provider First Name:
COURTNEY
Provider Middle Name:
BROOKE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STEPHENSON
Provider Other First Name:
COURTNEY
Provider Other Middle Name:
BROOKE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1154552503
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
950 S TAMIAMI TRL
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
SARASOTA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34236-7840
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-330-5348
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
950 S TAMIAMI TRL
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
SARASOTA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34236-7840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-330-5348
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/03/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  ISW 4582 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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