Provider Demographics
NPI:1770793309
Name:CODNER, DORRETT M (NP)
Entity type:Individual
Prefix:
First Name:DORRETT
Middle Name:M
Last Name:CODNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2900 CORPORATE WAY
Mailing Address - Street 2:DOOR D
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025
Mailing Address - Country:US
Mailing Address - Phone:954-276-5663
Mailing Address - Fax:954-276-0301
Practice Address - Street 1:703 N FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1006
Practice Address - Country:US
Practice Address - Phone:954-265-9976
Practice Address - Fax:954-965-5396
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2021-03-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP 1277362363LF0000X
FLARNP1277362363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily