Provider Demographics
NPI:1184695066
Name:CORBETT, FELICIA ANNASTACIA (PA-C)
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:ANNASTACIA
Last Name:CORBETT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:FELICIA
Other - Middle Name:ANNASTACIA
Other - Last Name:TANNER-CORBETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:1800 HARRISON ST FL 7
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3466
Mailing Address - Country:US
Mailing Address - Phone:510-625-2856
Mailing Address - Fax:877-737-4262
Practice Address - Street 1:2315 STOCKTON BLVD
Practice Address - Street 2:SUITE 6312
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2201
Practice Address - Country:US
Practice Address - Phone:916-734-1695
Practice Address - Fax:916-734-2216
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18576363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
G20587Medicare UPIN
CA0PA185760Medicare PIN