Healthcare Provider Details

I. General information

NPI: 1124536578
Provider Name (Legal Business Name): CORINNE JENAY STEFFEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2018
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20602 RIDGECREST RD
LOCUST NC
28097-8354
US

IV. Provider business mailing address

20602 RIDGECREST RD
LOCUST NC
28097-8354
US

V. Phone/Fax

Practice location:
  • Phone: 904-673-1328
  • Fax: 704-368-0159
Mailing address:
  • Phone:
  • Fax: 704-368-0159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0010-15549
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9111023
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: