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General NPI Number Information
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NPI Number | 1588454029
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Entity Type | Individual
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Provider Name | DEJUANNA OUBRE CORSON RN, APRN
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Gender | Female
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Dates
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Enumeration Date | 05/08/2025
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 13148 VAIL RIDGE DR
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City | RIVERVIEW
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State | FL
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Zip | 33579-7187
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Country | US
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Telephone | 813-317-3930
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Fax | 813-317-3930
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Provider Business Mailing Address
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Address Line | 5222 LAKE TOSCANA DR
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City | WIMAUMA
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State | FL
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Zip | 33598-4433
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Country | US
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Telephone | 813-317-3930
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Fax | 813-790-6492
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN11040570
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN9636578
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License Number State | FL
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