Healthcare Provider Details

I. General information

NPI: 1871093948
Provider Name (Legal Business Name): COURTNEY A CORBOY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY NICHOLE AMBURGEY

II. Dates (important events)

Enumeration Date: 02/15/2018
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E LEIGH ST
RICHMOND VA
23298-5004
US

IV. Provider business mailing address

PO BOX 91734
RICHMOND VA
23291-1734
US

V. Phone/Fax

Practice location:
  • Phone: 804-628-4368
  • Fax: 804-807-7951
Mailing address:
  • Phone: 804-358-6100
  • Fax: 804-342-7619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110-006039
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: