Provider Demographics
NPI:1407120272
Name:CORREAL, WILLIAM DANIEL (PA-C)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DANIEL
Last Name:CORREAL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S PINE ISLAND RD STE 800
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3923
Mailing Address - Country:US
Mailing Address - Phone:954-753-7870
Mailing Address - Fax:954-752-0032
Practice Address - Street 1:5810 CORAL RIDGE DR STE 300
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33076-3377
Practice Address - Country:US
Practice Address - Phone:954-414-7700
Practice Address - Fax:954-840-0850
Is Sole Proprietor?:No
Enumeration Date:2012-02-26
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9109760363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107282500Medicaid