Fallon, Kourtney

Fallon, Kourtney is an individual health care provider with primary practice located at 17 Davis Blvd 100, Tampa FL 33606-3475. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Primary Care, Physician Assistants & Advanced Practice Nursing Providers / Pediatrics. Physician Assistants & Advanced Practice Nursing Providers / Pediatrics is her primary health care specialty. Fallon, Kourtney can be contacted via phone (813) 259-8700.

Contact Information

Primary practice address
17 Davis Blvd 100 Tampa FL 33606-3475
Phone: (813) 259-8700
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Primary Care 363LP2300X ARNP9296288 Florida
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X ARNP9296288 Florida

Profile Details

NPI number 1922470707
LBN Legal business name Fallon, Kourtney
Credentials ARNP
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 20th, 2015
Last updated Oct 27th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1922470707 NPPES
Florida Other AATWE BLUE CROSS BLUE SHIELD
Florida MEDICAID 015999900 BLUE CROSS BLUE SHIELD

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