Provider Demographics
NPI:1215906557
Name:CORREA, ROSARIO (ARNP)
Entity type:Individual
Prefix:
First Name:ROSARIO
Middle Name:
Last Name:CORREA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:466 SW PORT ST LUCIE BLVD STE 116
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-2091
Mailing Address - Country:US
Mailing Address - Phone:772-237-4518
Mailing Address - Fax:772-237-4622
Practice Address - Street 1:466 SW PORT ST LUCIE BLVD STE 116
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-2091
Practice Address - Country:US
Practice Address - Phone:772-237-4518
Practice Address - Fax:772-461-9972
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9200331363LP0200X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307735700Medicaid