Provider Demographics
NPI:1720972409
Name:ROSS, COURTNEY LYNN (ASSISTED LIVING)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LYNN
Last Name:ROSS
Suffix:
Gender:F
Credentials:ASSISTED LIVING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6403 JOE COTTON TRL
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-2320
Mailing Address - Country:US
Mailing Address - Phone:850-688-2456
Mailing Address - Fax:
Practice Address - Street 1:6403 JOE COTTON TRL
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-2320
Practice Address - Country:US
Practice Address - Phone:850-688-2456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376G00000XNursing Service Related ProvidersNursing Home Administrator