Healthcare Provider Details

I. General information

NPI: 1528996857
Provider Name (Legal Business Name): TAMMY CORKINS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2177 KINGSLEY AVE STE 11
ORANGE PARK FL
32073-5132
US

IV. Provider business mailing address

481 KEVIN DR
ORANGE PARK FL
32073-2776
US

V. Phone/Fax

Practice location:
  • Phone: 904-728-8970
  • Fax:
Mailing address:
  • Phone: 904-728-8970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA84683
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: