1104156199 NPI number — MS. KATHY ANNE CORBO ARNP

Table of content: MS. KATHY ANNE CORBO ARNP (NPI 1104156199)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104156199 NPI number — MS. KATHY ANNE CORBO ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORBO
Provider First Name:
KATHY
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104156199
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1002 S HARBOUR ISLAND BLVD
Provider Second Line Business Mailing Address:
UNIT #1610
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33602-5781
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-587-1386
Provider Business Mailing Address Fax Number:
727-733-9233

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1064 KEENE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUNEDIN
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34698-6300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-733-9202
Provider Business Practice Location Address Fax Number:
727-733-9202
Provider Enumeration Date:
01/13/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  ARNP3308452 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 364SA2200X , with the licence number: ARNP3308452 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)