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General NPI Number Information
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NPI Number | 1114597259
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Entity Type | Individual
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Provider Name | CORLISS Y PHILLIPS LPN
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Gender | Female
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Dates
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Enumeration Date | 06/30/2021
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Last Update Date | 12/21/2025
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Provider Practice Location Address
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Address Line | 1903 PLOVER AVE APT A
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City | FORT PIERCE
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State | FL
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Zip | 34949-3446
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Country | US
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Telephone | 772-940-3736
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Fax |
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Provider Business Mailing Address
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Address Line | 1903 PLOVER AVE APT A
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City | FORT PIERCE
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State | FL
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Zip | 34949-3446
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Country | US
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Telephone | 772-940-3736
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 234020
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number | 234020
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | 30212271
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 30212271
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number | 234020
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License Number State | FL
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Taxonomy #6
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number | 30212271
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License Number State | FL
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Taxonomy #7
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 5195534
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License Number State | FL
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Taxonomy #8
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 30212271
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License Number State | FL
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Taxonomy #9
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Taxonomy Code | 372500000X
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Taxonomy Name | Chore Provider
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License Number | 30212271
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License Number State | FL
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Taxonomy #10
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 30212271
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License Number State | FL
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Taxonomy #11
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number | 30212271
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License Number State | FL
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Taxonomy #12
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Taxonomy Code | 372500000X
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Taxonomy Name | Chore Provider
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License Number | 234020
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License Number State | FL
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Taxonomy #13
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | PN5195534
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License Number State | FL
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