Provider Demographics
NPI:1346708161
Name:MILTON, CORENTHEIA ANN
Entity Type:Individual
Prefix:
First Name:CORENTHEIA
Middle Name:ANN
Last Name:MILTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 W ROBSON ST
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-2138
Mailing Address - Country:US
Mailing Address - Phone:561-355-9284
Mailing Address - Fax:
Practice Address - Street 1:617 W ROBSON ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-2138
Practice Address - Country:US
Practice Address - Phone:561-355-9284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-11
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24604251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health