Individual
CORLISS Y PHILLIPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1903 PLOVER AVE APT A, FORT PIERCE, FL 34949-3446
(772) 940-3736
Mailing address
1903 PLOVER AVE APT A, FORT PIERCE, FL 34949-3446
(772) 940-3736
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
5195534
FL
251E00000X
Home Health Agency
30212271
FL
251J00000X
Nursing Care Agency
PN5195534
FL
251S00000X
Community/Behavioral Health Agency
30212271
FL
253Z00000X
In Home Supportive Care Agency
234020
FL
253Z00000X
In Home Supportive Care Agency
30212271
FL
372500000X
Chore Provider
234020
FL
372500000X
Chore Provider
30212271
FL
372600000X
Adult Companion
Primary
234020
FL
372600000X
Adult Companion
30212271
FL
374U00000X
Home Health Aide
30212271
FL
376J00000X
Homemaker
234020
FL
376J00000X
Homemaker
30212271
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0622
—
FL
05
—
127040900
—
FL
Enumeration date
06/30/2021
Last updated
12/21/2025
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