Provider Demographics
NPI:1124743125
Name:OLOUGHLIN, COURTNEY JENEL (PA-C)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:JENEL
Last Name:OLOUGHLIN
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:JENEL
Other - Last Name:SELDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:151 SOUTHHALL LN STE 300
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7172
Mailing Address - Country:US
Mailing Address - Phone:866-400-3376
Mailing Address - Fax:407-650-3455
Practice Address - Street 1:1507 PARK CENTER DR UNIT 1D1E
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-5795
Practice Address - Country:US
Practice Address - Phone:866-400-3376
Practice Address - Fax:407-293-3908
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9116521363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant