Provider Demographics
NPI:1942490735
Name:OLIVER, CORLISS YVETTE (MD)
Entity Type:Individual
Prefix:
First Name:CORLISS
Middle Name:YVETTE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1456 E MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-4817
Mailing Address - Country:US
Mailing Address - Phone:407-420-7691
Mailing Address - Fax:407-748-0134
Practice Address - Street 1:740 FLORIDA CENTRAL PKWY
Practice Address - Street 2:SUITE 1020
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-7651
Practice Address - Country:US
Practice Address - Phone:407-790-7123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-27
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94790207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYI24855Medicare UPIN