Provider Demographics
NPI:1982706701
Name:ACKERMAN, CORRIE E (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CORRIE
Middle Name:E
Last Name:ACKERMAN
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 1:646 VIRGINIA ST STE 204
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-6612
Mailing Address - Country:US
Mailing Address - Phone:727-736-3212
Mailing Address - Fax:813-635-2635
Practice Address - Street 1:646 VIRGINIA ST STE 204
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-6612
Practice Address - Country:US
Practice Address - Phone:727-736-3212
Practice Address - Fax:813-635-2635
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01023258OtherRAILROAD MEDICARE
FLY09CCOtherBCBS OF FLORIDA
FL004353300Medicaid
FLFQ152ZMedicare PIN