Provider Demographics
NPI:1366183717
Name:COROZA, ANABELLE BERNARDO
Entity type:Individual
Prefix:
First Name:ANABELLE
Middle Name:BERNARDO
Last Name:COROZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4654 BLOOMSBURY ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-6820
Mailing Address - Country:US
Mailing Address - Phone:863-801-1710
Mailing Address - Fax:
Practice Address - Street 1:4654 BLOOMSBURY ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-6820
Practice Address - Country:US
Practice Address - Phone:863-801-1710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-07
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3-000882363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily