Provider Demographics
NPI:1598583684
Name:WALFORD, COURTNAE LATONYA COOPER (PA-C)
Entity type:Individual
Prefix:
First Name:COURTNAE
Middle Name:LATONYA COOPER
Last Name:WALFORD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3300 S UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-2004
Mailing Address - Country:US
Mailing Address - Phone:754-422-8462
Mailing Address - Fax:
Practice Address - Street 1:2 N BELCHER RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-3201
Practice Address - Country:US
Practice Address - Phone:727-449-2224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-28
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9119305363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant