Provider Demographics
NPI:1023005782
Name:KORBA, ELIZABETH DOLORES (ARNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DOLORES
Last Name:KORBA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1470 SE COLCHESTER CIR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-4201
Mailing Address - Country:US
Mailing Address - Phone:772-335-7857
Mailing Address - Fax:
Practice Address - Street 1:1110 35TH LN
Practice Address - Street 2:VNA MOBILE UNIT
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6549
Practice Address - Country:US
Practice Address - Phone:772-567-5551
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1395142363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner