Provider Demographics
NPI:1790321826
Name:KOERBEL, STACI (CRNP)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:
Last Name:KOERBEL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:STACI
Other - Middle Name:ROBYN
Other - Last Name:SABLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3400 CIVIC CENTER BLVD FL 1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5161
Mailing Address - Country:US
Mailing Address - Phone:215-615-5864
Mailing Address - Fax:215-349-8432
Practice Address - Street 1:3400 CIVIC CENTER BLVD FL 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5161
Practice Address - Country:US
Practice Address - Phone:215-615-5864
Practice Address - Fax:215-349-8432
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-25
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP020983363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care