Provider Demographics
NPI:1235604836
Name:PADGETT, CORINNE RUTH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CORINNE
Middle Name:RUTH
Last Name:PADGETT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:CORINNE
Other - Middle Name:RUTH
Other - Last Name:GRATIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:29253 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:29253 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2102
Practice Address - Country:US
Practice Address - Phone:713-779-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9111795363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant