Provider Demographics
NPI:1265116461
Name:CORBO, STEPHANIE MONIQUE (FNP-C)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MONIQUE
Last Name:CORBO
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 1:10450 NW 20TH CT
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33322-3521
Mailing Address - Country:US
Mailing Address - Phone:786-226-2679
Mailing Address - Fax:
Practice Address - Street 1:15814 W STATE ROAD 84
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33326-1227
Practice Address - Country:US
Practice Address - Phone:954-715-2997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11026800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily