Provider Demographics
NPI:1740948355
Name:LEON CORCOBA, ELIZABETH (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:LEON CORCOBA
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 S MOON AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5716
Mailing Address - Country:US
Mailing Address - Phone:813-330-7033
Mailing Address - Fax:813-530-4066
Practice Address - Street 1:205 S MOON AVE STE 105
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5716
Practice Address - Country:US
Practice Address - Phone:813-330-7033
Practice Address - Fax:813-530-4066
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-30
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11016813207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine