Provider Demographics
NPI:1437745205
Name:CORREA, DANIEL (APRN)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:CORREA
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 NW 103RD AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33322-6843
Mailing Address - Country:US
Mailing Address - Phone:786-457-8691
Mailing Address - Fax:
Practice Address - Street 1:2560 NW 103RD AVE APT 202
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33322-6843
Practice Address - Country:US
Practice Address - Phone:786-457-8691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11010690363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily