Provider Demographics
NPI:1821286170
Name:ASADI-FRAZIER, CORY F (NP)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:F
Last Name:ASADI-FRAZIER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CORY
Other - Middle Name:
Other - Last Name:FRAZIER ANTONELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:601 E ROLLINS ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1248
Mailing Address - Country:US
Mailing Address - Phone:407-975-0412
Mailing Address - Fax:407-975-0413
Practice Address - Street 1:601 E ROLLINS ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1248
Practice Address - Country:US
Practice Address - Phone:407-975-0412
Practice Address - Fax:407-975-0413
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2019-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704300463363L00000X
OHRN-296830/NP-07044363LP0200X
FLAPRN11000729363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2340416Medicaid