Provider Demographics
NPI:1215478698
Name:COREA, DAISY
Entity type:Individual
Prefix:
First Name:DAISY
Middle Name:
Last Name:COREA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 W VINE ST
Mailing Address - Street 2:268
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4643
Mailing Address - Country:US
Mailing Address - Phone:863-242-8844
Mailing Address - Fax:
Practice Address - Street 1:3501 W VINE ST
Practice Address - Street 2:268
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4643
Practice Address - Country:US
Practice Address - Phone:863-242-8844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-17
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL648586Medicaid