Healthcare Provider Details

I. General information

NPI: 1104156199
Provider Name (Legal Business Name): KATHY ANNE CORBO ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2010
Last Update Date: 01/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1064 KEENE RD
DUNEDIN FL
34698-6300
US

IV. Provider business mailing address

1002 S HARBOUR ISLAND BLVD UNIT #1610
TAMPA FL
33602-5781
US

V. Phone/Fax

Practice location:
  • Phone: 727-733-9202
  • Fax: 727-733-9202
Mailing address:
  • Phone: 941-587-1386
  • Fax: 727-733-9233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP3308452
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberARNP3308452
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: