Corbett Family Medical Center PLC

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA9106885 Issued in FL

Legal business name

CORBETT FAMILY MEDICAL CENTER PLC

Practice address

4991 Royal Gulf Cir
Fort Myers, FL 33966-7006

Phone

(239) 333-4100

Fax

(239) 333-4101

NPI assigned

Jul 23, 2014

Last updated

Apr 1, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Crista Corbett, PA

Title

Physician Assistant

Phone

(239) 333-4100

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1406073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459468800000",
    "number": "1679981641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4991 ROYAL GULF CIR",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339667006",
            "telephone_number": "239-333-4100",
            "fax_number": "239-333-4101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4991 ROYAL GULF CIR",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339667006",
            "telephone_number": "239-333-4100",
            "fax_number": "239-333-4101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORBETT FAMILY MEDICAL CENTER PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-23",
        "last_updated": "2016-04-01",
        "status": "A",
        "authorized_official_last_name": "CORBETT",
        "authorized_official_first_name": "CRISTA",
        "authorized_official_title_or_position": "PHYSICIAN ASSISTANT",
        "authorized_official_telephone_number": "239-333-4100",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9106885",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "OS7984",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "PA 9106885",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Coral House Assisted Living Community, LLC
• Coral Medical Center LLC
• Coram Alternate Site Services, Inc. (Coram CVS/specialty Infusion Services)
• Jean Corbae, M.A.
• Michael A Corbellini, DO
• Traci Ann Corby, ARNP
• Jennifer Christine Cordeiro
• Tina Marie Cordell
• Pamela K Corder, LPN
• Valerie N. Cordero Mendez, MD

• Medical Physician Assistant in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.