Provider Demographics
NPI:1023521887
Name:CORSE, CARLIE SUE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:CARLIE
Middle Name:SUE
Last Name:CORSE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8592 WELLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93004-2507
Mailing Address - Country:US
Mailing Address - Phone:805-901-0761
Mailing Address - Fax:
Practice Address - Street 1:2772 JOHNSON DR STE 100
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-7261
Practice Address - Country:US
Practice Address - Phone:805-642-1430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95007990363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily