Provider Demographics
NPI:1770058810
Name:CORTES, KARINA (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:KARINA
Middle Name:
Last Name:CORTES
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 JOHNSON ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021
Mailing Address - Country:US
Mailing Address - Phone:954-961-7771
Mailing Address - Fax:954-961-9633
Practice Address - Street 1:3800 JOHNSON ST
Practice Address - Street 2:SUITE D
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021
Practice Address - Country:US
Practice Address - Phone:954-961-7771
Practice Address - Fax:954-961-9633
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9111569363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical