Provider Demographics
NPI:1598898835
Name:CORBIN, WENDY M (ARNP-C)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:M
Last Name:CORBIN
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 BRICKYARD RD
Mailing Address - Street 2:
Mailing Address - City:CHIPLEY
Mailing Address - State:FL
Mailing Address - Zip Code:32428-6303
Mailing Address - Country:US
Mailing Address - Phone:850-638-1610
Mailing Address - Fax:850-638-0622
Practice Address - Street 1:1376 BRICKYARD RD
Practice Address - Street 2:SUITE 4
Practice Address - City:CHIPLEY
Practice Address - State:FL
Practice Address - Zip Code:32428-6391
Practice Address - Country:US
Practice Address - Phone:850-638-0552
Practice Address - Fax:850-638-0504
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3358302363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP3358302OtherFL ARNP LICENSE