Basic Information
Provider Information
NPI: 1891848768
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CORKERY
FirstName: KAREN
MiddleName: ANN
NamePrefix:  
NameSuffix:  
Credential: APRN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 505 OAKFIELD DR
Address2:  
City: BRANDON
State: FL
PostalCode: 335115700
CountryCode: US
TelephoneNumber: 8136842229
FaxNumber: 8138130330
Practice Location
Address1: 505 OAKFIELD DR
Address2:  
City: BRANDON
State: FL
PostalCode: 335115700
CountryCode: US
TelephoneNumber: 8136842229
FaxNumber: 8138130330
Other Information
ProviderEnumerationDate: 01/22/2007
LastUpdateDate: 01/20/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/20/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LX0001X9206795FLN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
363LW0102XAPRN9206795FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health

No ID Information.


Home