Healthcare Provider Details

I. General information

NPI: 1033813175
Provider Name (Legal Business Name): JANIE CORCORAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12529 YELLOW BLUFF RD STE 6 #172
JACKSONVILLE FL
32226-3813
US

IV. Provider business mailing address

12529 YELLOW BLUFF RD STE 6 #172
JACKSONVILLE FL
32226-3813
US

V. Phone/Fax

Practice location:
  • Phone: 904-785-8654
  • Fax:
Mailing address:
  • Phone: 904-785-8654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number86213
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH25976
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: