Individual
COREY THACKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6801 ROOSEVELT BLVD BLDG 938, JACKSONVILLE, FL 32212-1192
(407) 325-9229
Mailing address
2828 CEDARCREST DR, ORANGE PARK, FL 32073-6512
(407) 325-9229
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
03/03/2016
Last updated
04/17/2025
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