Provider Demographics
NPI:1275959892
Name:CORBETT, CHRISTIAN JOHN (RN, CRNA)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:JOHN
Last Name:CORBETT
Suffix:
Gender:M
Credentials:RN, CRNA
Other - Prefix:
Other - First Name:CHRISTIAN
Other - Middle Name:JOHN
Other - Last Name:CORBETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA, RN
Mailing Address - Street 1:6530 ANCHOR LOOP
Mailing Address - Street 2:#302
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34212-4409
Mailing Address - Country:US
Mailing Address - Phone:616-498-9494
Mailing Address - Fax:
Practice Address - Street 1:1261 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2219
Practice Address - Country:US
Practice Address - Phone:941-917-8267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-06
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704269328367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered