Provider Demographics
NPI:1386129328
Name:CORLEY, DEBRA SHARENE (DNP, RN, AGNP-C)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:SHARENE
Last Name:CORLEY
Suffix:
Gender:F
Credentials:DNP, RN, AGNP-C
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:8996 W POTTER DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-6482
Mailing Address - Country:US
Mailing Address - Phone:623-203-9481
Mailing Address - Fax:
Practice Address - Street 1:9139 W THUNDERBIRD RD STE 265
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4922
Practice Address - Country:US
Practice Address - Phone:623-777-4567
Practice Address - Fax:623-777-4497
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-25
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ217888363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology