Healthcare Provider Details

I. General information

NPI: 1598898835
Provider Name (Legal Business Name): WENDY M CORBIN ARNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1376 BRICKYARD RD SUITE 4
CHIPLEY FL
32428-6391
US

IV. Provider business mailing address

1360 BRICKYARD RD
CHIPLEY FL
32428-6303
US

V. Phone/Fax

Practice location:
  • Phone: 850-638-0552
  • Fax: 850-638-0504
Mailing address:
  • Phone: 850-638-1610
  • Fax: 850-638-0622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP3358302
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: