Provider Demographics
NPI:1164905741
Name:CORRENTI, DANA (PA-C)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:CORRENTI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:VAN CLEVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4347 WILLOW POND CIR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-8248
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3111 S CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:SOUTH MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53172-3607
Practice Address - Country:US
Practice Address - Phone:414-376-9945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2020-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9111551363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant