Basic Information
| Provider Information | |||||||||
| NPI: | 1215906557 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CORREA | ||||||||
| FirstName: | ROSARIO | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 466 SW PORT ST LUCIE BLVD STE 116 | ||||||||
| Address2: | |||||||||
| City: | PORT ST LUCIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349532091 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7722374518 | ||||||||
| FaxNumber: | 7722374622 | ||||||||
| Practice Location | |||||||||
| Address1: | 466 SW PORT ST LUCIE BLVD STE 116 | ||||||||
| Address2: | |||||||||
| City: | PORT ST LUCIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349532091 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7722374518 | ||||||||
| FaxNumber: | 7724619972 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2006 | ||||||||
| LastUpdateDate: | 09/30/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | APRN9200331 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 307735700 | 05 | FL | MEDICAID |