Provider Demographics
NPI:1629027396
Name:HASPIL-CORGAN, TESSA ANTONIA (MD)
Entity type:Individual
Prefix:
First Name:TESSA
Middle Name:ANTONIA
Last Name:HASPIL-CORGAN
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 1:12300 SW 69TH PL
Mailing Address - Street 2:
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-5436
Mailing Address - Country:US
Mailing Address - Phone:201-334-7974
Mailing Address - Fax:
Practice Address - Street 1:8900 NORTH KENDALL DRIVE
Practice Address - Street 2:EMERGENCY SERVICES
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1106
Practice Address - Country:US
Practice Address - Phone:954-240-2572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0093280207P00000X
FLME93280207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBH6849472OtherDEA