Provider Demographics
NPI:1154602019
Name:CORREA, CORINNE ELISSA
Entity type:Individual
Prefix:MISS
First Name:CORINNE
Middle Name:ELISSA
Last Name:CORREA
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 1:12812 EARLY RUN LN
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-3376
Mailing Address - Country:US
Mailing Address - Phone:813-677-7460
Mailing Address - Fax:
Practice Address - Street 1:12812 EARLY RUN LN
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-3376
Practice Address - Country:US
Practice Address - Phone:813-677-7460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR33871163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse