Provider Demographics
NPI:1275188559
Name:CORBIN, MAITE JACQUAY (DNP, APRN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MAITE
Middle Name:JACQUAY
Last Name:CORBIN
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-BC
Other - Prefix:MS
Other - First Name:MAITE
Other - Middle Name:JACQUAY
Other - Last Name:CEPEDA-ALLENDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:224-D CORNWALL STREET, NW, SUITE 403
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-3346
Mailing Address - Country:US
Mailing Address - Phone:703-737-6010
Mailing Address - Fax:703-443-8643
Practice Address - Street 1:46440 BENEDICT DRIVE , SUITE 107
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-6602
Practice Address - Country:US
Practice Address - Phone:703-450-1125
Practice Address - Fax:703-450-1145
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024177940363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA30017438120001Medicaid
VA1275188559Medicaid