Basic Information
| Provider Information | |||||||||
| NPI: | 1649993551 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AUBERTINE | ||||||||
| FirstName: | CORTNEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5560 NE STATE ROAD 121 | ||||||||
| Address2: | |||||||||
| City: | WILLISTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326965787 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5857302992 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4600 SW 46TH CT STE 150 | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344745753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523695999 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2022 | ||||||||
| LastUpdateDate: | 09/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 11022022 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.