Provider Demographics
NPI:1366433500
Name:FOLLETT, CORRINNE (ARNP)
Entity type:Individual
Prefix:
First Name:CORRINNE
Middle Name:
Last Name:FOLLETT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5307 MAIN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-2536
Mailing Address - Country:US
Mailing Address - Phone:727-847-3733
Mailing Address - Fax:727-841-0384
Practice Address - Street 1:5307 MAIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-2536
Practice Address - Country:US
Practice Address - Phone:727-847-3733
Practice Address - Fax:727-841-0384
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN551832363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL303873400Medicaid
FL33448AOtherBLUE CROSS BLUE SHIELD
FL303873400Medicaid
FL33448AOtherBLUE CROSS BLUE SHIELD