1255724712 NPI number — REBECCA CORCORAN ARNP, FNP-C

Table of content: REBECCA CORCORAN ARNP, FNP-C (NPI 1255724712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255724712 NPI number — REBECCA CORCORAN ARNP, FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORCORAN
Provider First Name:
REBECCA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP, FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255724712
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3340 TAMIAMI TRAIL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT CHARLOTTE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33952-8088
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-764-5858
Provider Business Mailing Address Fax Number:
941-764-1657

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3340 TAMIAMI TRAIL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT CHARLOTTE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33952-8088
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-764-5858
Provider Business Practice Location Address Fax Number:
941-764-1657
Provider Enumeration Date:
03/09/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  ARNP9251386 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: Y0R0V . This is a "BC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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