Provider Demographics
NPI:1679163422
Name:CORPUS, JOSE CARLOS SABIO (APRN-CRNA)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:CARLOS SABIO
Last Name:CORPUS
Suffix:
Gender:M
Credentials:APRN-CRNA
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:CARLOS
Other - Last Name:CORPUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-8487
Mailing Address - Fax:
Practice Address - Street 1:2213 CHERRY ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-2603
Practice Address - Country:US
Practice Address - Phone:419-251-3232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX134177367500000X
OHAPRN.CRNA.0020286367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered