Provider Demographics
NPI:1306386974
Name:CORSA, ERIN K (NP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:K
Last Name:CORSA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 LIVELY OAKS ROAD
Mailing Address - Street 2:
Mailing Address - City:LIVELY
Mailing Address - State:VA
Mailing Address - Zip Code:22507
Mailing Address - Country:US
Mailing Address - Phone:804-462-5155
Mailing Address - Fax:804-462-5922
Practice Address - Street 1:36 LIVELY OAKS ROAD
Practice Address - Street 2:
Practice Address - City:LIVELY
Practice Address - State:VA
Practice Address - Zip Code:22507
Practice Address - Country:US
Practice Address - Phone:804-462-5155
Practice Address - Fax:804-462-5922
Is Sole Proprietor?:No
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174608363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05382OtherGROUP PTAN