Provider Demographics
NPI:1861858789
Name:DEVEAUX, CORLETTE
Entity Type:Individual
Prefix:
First Name:CORLETTE
Middle Name:
Last Name:DEVEAUX
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 1:12201 PEMBROKE RD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-1725
Mailing Address - Country:US
Mailing Address - Phone:751-210-3374
Mailing Address - Fax:954-362-4923
Practice Address - Street 1:12201 PEMBROKE RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-1725
Practice Address - Country:US
Practice Address - Phone:751-210-3374
Practice Address - Fax:954-362-4923
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
347B00000X
FL236440253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347B00000XTransportation ServicesBus
No253Z00000XAgenciesIn Home Supportive Care