Provider Demographics
NPI:1275591158
Name:LOBLACK, CORINTHIA (NP-C)
Entity Type:Individual
Prefix:
First Name:CORINTHIA
Middle Name:
Last Name:LOBLACK
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:CORINTHIA
Other - Middle Name:
Other - Last Name:LOBLACK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:2426 MARLEY CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-9132
Mailing Address - Country:US
Mailing Address - Phone:407-579-9589
Mailing Address - Fax:
Practice Address - Street 1:7200 LAKE ELLENOR DR STE 116
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-5786
Practice Address - Country:US
Practice Address - Phone:407-710-0530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2747962363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY095PMedicaid
FLQ69781Medicare PIN