Provider Demographics
NPI:1174333264
Name:TORTORELLA, CORRINE A
Entity type:Individual
Prefix:
First Name:CORRINE
Middle Name:A
Last Name:TORTORELLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3375 NW 1ST CT APT 435
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-2667
Mailing Address - Country:US
Mailing Address - Phone:845-750-7329
Mailing Address - Fax:754-205-5714
Practice Address - Street 1:3375 NW 1ST CT APT 435
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-2667
Practice Address - Country:US
Practice Address - Phone:845-750-7329
Practice Address - Fax:754-205-5714
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service