Provider Demographics
NPI:1255773750
Name:FRUSCELLA, COURTNEY ELIZABETH (PNP-AC)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ELIZABETH
Last Name:FRUSCELLA
Suffix:
Gender:F
Credentials:PNP-AC
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:ELIZABETH
Other - Last Name:HOPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:6780 MAYFIELD RD
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2203
Mailing Address - Country:US
Mailing Address - Phone:440-312-7337
Mailing Address - Fax:
Practice Address - Street 1:6780 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124
Practice Address - Country:US
Practice Address - Phone:440-312-7337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.14304-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH14304OtherCOA