Organization
CORBETT FAMILY MEDICAL CENTER PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRISTA CORBETT PA (PHYSICIAN ASSISTANT)
(239) 333-4100
Entity
Organization
Contact information
Practice address
4991 ROYAL GULF CIR, FORT MYERS, FL 33966-7006
(239) 333-4100
(239) 333-4101
Mailing address
4991 ROYAL GULF CIR, FORT MYERS, FL 33966-7006
(239) 333-4100
(239) 333-4101
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9106885
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OS7984
MEDICAL LICENSE
FL
01
—
PA 9106885
MEDICAL LICENSE
FL
Enumeration date
07/23/2014
Last updated
04/01/2016
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