Provider Demographics
NPI:1841434057
Name:CORBINE, THERESA M (FNP-C)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:M
Last Name:CORBINE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:M
Other - Last Name:COKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-395-8900
Mailing Address - Fax:757-395-8935
Practice Address - Street 1:1080 FIRST COLONIAL RD
Practice Address - Street 2:SUITE 305
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2406
Practice Address - Country:US
Practice Address - Phone:757-395-8900
Practice Address - Fax:757-395-8935
Is Sole Proprietor?:No
Enumeration Date:2009-05-01
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024168290363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10045279NOtherSENTARA/OPTIMA HEALTH
VA1841434057Medicaid
VAPAROtherVIRGINIA PREMIER HEALTH
VAPAROtherUSA MANAGED CARE
NC7004359Medicaid
VAPAROtherCORVEL/CORCARE
VAPAROtherMULTIPLAN
VA-023OtherTRICARE/CHAMPUS
VAVAA102419Medicare PIN