Provider Demographics
NPI:1083775183
Name:ALVARADO, CORAZON P (APN)
Entity Type:Individual
Prefix:
First Name:CORAZON
Middle Name:P
Last Name:ALVARADO
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 JORDAN RD SW
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:08701-3324
Mailing Address - Country:US
Mailing Address - Phone:256-844-2825
Mailing Address - Fax:256-844-1804
Practice Address - Street 1:2202 JORDAN RD SW
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35968-3691
Practice Address - Country:US
Practice Address - Phone:256-844-2825
Practice Address - Fax:256-844-1804
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN05817300363LA2200X
AL1-143265363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8105804Medicaid
NJ034509Medicare ID - Type Unspecified