Provider Demographics
NPI:1427155589
Name:FITCH, CORINA MAE (LM, CPM)
Entity type:Individual
Prefix:MISS
First Name:CORINA
Middle Name:MAE
Last Name:FITCH
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 CREEKVIEW ROAD
Mailing Address - Street 2:
Mailing Address - City:SUMMERTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38483
Mailing Address - Country:US
Mailing Address - Phone:305-308-5900
Mailing Address - Fax:786-515-9874
Practice Address - Street 1:198 SECOND ROAD
Practice Address - Street 2:
Practice Address - City:SUMMERTOWN
Practice Address - State:TN
Practice Address - Zip Code:38483
Practice Address - Country:US
Practice Address - Phone:305-308-5900
Practice Address - Fax:786-515-9874
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW102176B00000X
TN101176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340371800Medicaid
FLY0549OtherBCBS PROVIDER NUMBER