Provider Demographics
NPI:1457167561
Name:GREENE, CORI (AGPCNP)
Entity type:Individual
Prefix:MS
First Name:CORI
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6870 FREEDOM ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-2830
Mailing Address - Country:US
Mailing Address - Phone:267-226-4725
Mailing Address - Fax:
Practice Address - Street 1:8975 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-8901
Practice Address - Country:US
Practice Address - Phone:561-637-3933
Practice Address - Fax:561-899-5787
Is Sole Proprietor?:No
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11036575363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology