Provider Demographics
NPI:1356683916
Name:CORINE, KELLY KRISTINA (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:KRISTINA
Last Name:CORINE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12470 TELECOM DR
Mailing Address - Street 2:SUITE 300 WEST
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33637-0904
Mailing Address - Country:US
Mailing Address - Phone:813-871-8200
Mailing Address - Fax:813-871-8199
Practice Address - Street 1:12470 TELECOM DR
Practice Address - Street 2:SUITE 300 WEST
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33637-0904
Practice Address - Country:US
Practice Address - Phone:813-871-8200
Practice Address - Fax:813-871-8199
Is Sole Proprietor?:No
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP9279639363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health