Provider Demographics
NPI:1437465176
Name:CORDIS, BIRGET ANN (ARNP)
Entity Type:Individual
Prefix:MS
First Name:BIRGET
Middle Name:ANN
Last Name:CORDIS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:BIRGET
Other - Middle Name:
Other - Last Name:BUNBURY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2501 MARSHFIELD PRESERVE WAY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-2272
Mailing Address - Country:US
Mailing Address - Phone:407-863-6389
Mailing Address - Fax:407-209-0332
Practice Address - Street 1:2501 MARSHFIELD PRESERVE WAY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-2272
Practice Address - Country:US
Practice Address - Phone:407-863-6389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9320109363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003869400Medicaid
FL003869400Medicaid