Provider Demographics
NPI:1588454029
Name:CORSON, DEJUANNA OUBRE (RN, APRN)
Entity type:Individual
Prefix:
First Name:DEJUANNA
Middle Name:OUBRE
Last Name:CORSON
Suffix:
Gender:F
Credentials:RN, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5222 LAKE TOSCANA DR
Mailing Address - Street 2:
Mailing Address - City:WIMAUMA
Mailing Address - State:FL
Mailing Address - Zip Code:33598-4433
Mailing Address - Country:US
Mailing Address - Phone:813-317-3930
Mailing Address - Fax:813-790-6492
Practice Address - Street 1:13148 VAIL RIDGE DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-7187
Practice Address - Country:US
Practice Address - Phone:813-317-3930
Practice Address - Fax:813-317-3930
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-08
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9636578163W00000X
FLAPRN11040570363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse