Healthcare Provider Details

I. General information

NPI: 1902095037
Provider Name (Legal Business Name): KORTNI S FLYNN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 03/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 W DR MARTIN LUTHER KING JR BLVD
TAMPA FL
33607-6307
US

IV. Provider business mailing address

PO BOX 10744
CLEARWATER FL
33757-8744
US

V. Phone/Fax

Practice location:
  • Phone: 813-870-4933
  • Fax: 813-870-4887
Mailing address:
  • Phone: 727-532-0002
  • Fax: 727-266-4928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME 105149
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME105149
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME 105149
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: