Provider Demographics
NPI:1912261918
Name:HEBB, CORISSA (NP-C)
Entity Type:Individual
Prefix:
First Name:CORISSA
Middle Name:
Last Name:HEBB
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5445 DTC PKWY STE 1130
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-3038
Mailing Address - Country:US
Mailing Address - Phone:720-749-5599
Mailing Address - Fax:720-925-5897
Practice Address - Street 1:10375 PARK MEADOWS DR STE 270
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-6760
Practice Address - Country:US
Practice Address - Phone:303-351-5995
Practice Address - Fax:720-925-5897
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0168230163W00000X
MNR2099831363L00000X
COAPN.0993488-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNENROLLEDMedicaid
IAENROLLEDMedicaid
MN500007972Medicare PIN