Provider Demographics
NPI:1003205063
Name:CORREOSO, AMY SAUMELL (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:SAUMELL
Last Name:CORREOSO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:LAUREN
Other - Last Name:SAUMELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:7800 SW 87TH AVE, SUITE C-300
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173
Mailing Address - Country:US
Mailing Address - Phone:305-274-0221
Mailing Address - Fax:305-274-7775
Practice Address - Street 1:7800 SW 87TH AVE, SUITE C-300
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173
Practice Address - Country:US
Practice Address - Phone:305-274-0221
Practice Address - Fax:305-274-7775
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-14
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108077363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical