Provider Demographics
NPI:1841880028
Name:KOMOROWSKI, KOREY ANN
Entity type:Individual
Prefix:
First Name:KOREY
Middle Name:ANN
Last Name:KOMOROWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:871 VENETIA BAY BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-8047
Mailing Address - Country:US
Mailing Address - Phone:941-416-2077
Mailing Address - Fax:
Practice Address - Street 1:871 VENETIA BAY BLVD STE 203
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-8047
Practice Address - Country:US
Practice Address - Phone:941-416-2077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCRC1332010171W00000X, 171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
No171W00000XOther Service ProvidersContractor