Provider Demographics
NPI:1780738823
Name:TRUSOCK, CORINNE HELENA (PA-C)
Entity type:Individual
Prefix:
First Name:CORINNE
Middle Name:HELENA
Last Name:TRUSOCK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 S OCEAN DR STE 209
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33019-2915
Mailing Address - Country:US
Mailing Address - Phone:305-466-9988
Mailing Address - Fax:305-466-9989
Practice Address - Street 1:QSM-GA, INC-SNF
Practice Address - Street 2:1821 ANDERSON AVE NW
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:33014-1835
Practice Address - Country:US
Practice Address - Phone:305-466-9988
Practice Address - Fax:305-466-9989
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9564363A00000X
MI5601003291363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI970020813OtherRAILROAD RETIREMENT
MAG86360OtherPRIORITY HEALTH
MI970020813OtherRAILROAD RETIREMENT
MI0N31370Medicare ID - Type Unspecified