Provider Demographics
NPI:1497459465
Name:DISTEFANO-MANOLAS, COURTNEY (MSN, FNP-BC, PCCN)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:DISTEFANO-MANOLAS
Suffix:
Gender:F
Credentials:MSN, FNP-BC, PCCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8512 BLUE CYPRESS DR
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33467-6245
Mailing Address - Country:US
Mailing Address - Phone:929-235-6150
Mailing Address - Fax:
Practice Address - Street 1:1425 S CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-6384
Practice Address - Country:US
Practice Address - Phone:954-829-0391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2022092770363LF0000X
FL11025901363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily