Provider Demographics
NPI:1972789287
Name:AUDETTE, CORINNE R (CNM)
Entity type:Individual
Prefix:
First Name:CORINNE
Middle Name:R
Last Name:AUDETTE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:CORINNE
Other - Middle Name:R
Other - Last Name:ROY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:550 E STATE ROAD 434
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-5222
Mailing Address - Country:US
Mailing Address - Phone:407-262-5800
Mailing Address - Fax:407-331-4840
Practice Address - Street 1:550 E STATE ROAD 434
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5222
Practice Address - Country:US
Practice Address - Phone:407-262-5800
Practice Address - Fax:407-331-4840
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9249911367A00000X
TNAPN17215367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL309112100Medicaid