Provider Demographics
NPI:1669466165
Name:CORZINE, PATRICIA (NP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:CORZINE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:BURGIN-GABHARDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1263 HOSPITAL DR NW
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CORYDON
Mailing Address - State:IN
Mailing Address - Zip Code:47112-2172
Mailing Address - Country:US
Mailing Address - Phone:812-734-0912
Mailing Address - Fax:812-738-8715
Practice Address - Street 1:315 E BROADWAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3700
Practice Address - Country:US
Practice Address - Phone:502-629-2500
Practice Address - Fax:502-629-2055
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001325363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78007044Medicaid
KY50026824OtherPASSPORT HEALTH PLANS
IN200381740Medicaid
IN200465250Medicaid
KY50026824OtherPASSPORT HEALTH PLANS
IN200465250Medicaid
IN129980PPMedicare PIN
KY78007044Medicaid