Provider Demographics
NPI:1538697123
Name:COROLIUC, OXANA (PA-C)
Entity Type:Individual
Prefix:
First Name:OXANA
Middle Name:
Last Name:COROLIUC
Suffix:
Gender:F
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 1:63 EDDIE DOWLING HWY STE 8
Mailing Address - Street 2:
Mailing Address - City:NORTH SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02896-7322
Mailing Address - Country:US
Mailing Address - Phone:781-666-2711
Mailing Address - Fax:781-666-2712
Practice Address - Street 1:63 EDDIE DOWLING HWY STE 8
Practice Address - Street 2:
Practice Address - City:NORTH SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02896-7322
Practice Address - Country:US
Practice Address - Phone:781-666-2711
Practice Address - Fax:781-666-2712
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-26
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9110373363A00000X
RIPA01602363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant