MEDICARE: MORGAN K CORMIER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	11047947	FL
2	163W00000X	Registered Nurse	RN9452320	FL

General Provider Information

NPI Number	:	1669216040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MORGAN K CORMIER

Provider Business Mailing Address
First Line	:	8621 OAKWOOD DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33810-1293
Country	:	US
Telephone Number	:	561-420-7034
Fax Number	:

Provider Business Practice Location Address
First Line	:	52 UNDERWOOD ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32806-1110
Country	:	US
Telephone Number	:	321-841-5210
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2024
Last Update Date	:	06/02/2026

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