Healthcare Provider Details

I. General information

NPI: 1275959892
Provider Name (Legal Business Name): CHRISTIAN JOHN CORBETT RN, CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CHRISTIAN JOHN CORBETT CRNA, RN

II. Dates (important events)

Enumeration Date: 03/06/2014
Last Update Date: 06/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1261 S TAMIAMI TRL
SARASOTA FL
34239-2219
US

IV. Provider business mailing address

6530 ANCHOR LOOP #302
BRADENTON FL
34212-4409
US

V. Phone/Fax

Practice location:
  • Phone: 941-917-8267
  • Fax:
Mailing address:
  • Phone: 616-498-9494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704269328
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: