Provider Demographics
NPI:1528529708
Name:VANCE, COURTNEY MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:MARIE
Last Name:VANCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3621 MOLLY PITCHER CT
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4000
Mailing Address - Country:US
Mailing Address - Phone:210-837-0584
Mailing Address - Fax:
Practice Address - Street 1:2770 CAPITAL MEDICAL BLVD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-8417
Practice Address - Country:US
Practice Address - Phone:850-391-3880
Practice Address - Fax:833-450-6214
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME157061207V00000X
FLTRN29432207V00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program