Provider Demographics
NPI:1992901516
Name:CORSON, SYLVIA (AHCA PROVIDER)
Entity type:Individual
Prefix:MS
First Name:SYLVIA
Middle Name:
Last Name:CORSON
Suffix:
Gender:F
Credentials:AHCA PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 LAS VERDES CIR
Mailing Address - Street 2:APT. 114
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-8094
Mailing Address - Country:US
Mailing Address - Phone:561-495-9671
Mailing Address - Fax:561-495-9671
Practice Address - Street 1:5100 LAS VERDES CIR
Practice Address - Street 2:APT. 114
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-8094
Practice Address - Country:US
Practice Address - Phone:561-495-9671
Practice Address - Fax:561-495-9671
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL229170372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL229170OtherAHCA LICENSE NUMBER