Provider Demographics
NPI:1386735934
Name:CORBETT, TAMI J (ARNP)
Entity type:Individual
Prefix:
First Name:TAMI
Middle Name:J
Last Name:CORBETT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:TAMI
Other - Middle Name:
Other - Last Name:HANSCOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:21616 76TH AVE W STE 205
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7512
Mailing Address - Country:US
Mailing Address - Phone:425-640-4810
Mailing Address - Fax:425-640-4884
Practice Address - Street 1:21616 76TH AVE W STE 205
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7512
Practice Address - Country:US
Practice Address - Phone:425-640-4810
Practice Address - Fax:425-640-4884
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30002143363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9610197Medicaid
WA9610197Medicaid