Provider Demographics
NPI:1558111484
Name:CORREDOR, JENNY (FNP)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:CORREDOR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3932 W BAY VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-1234
Mailing Address - Country:US
Mailing Address - Phone:813-767-3384
Mailing Address - Fax:
Practice Address - Street 1:1 N DALE MABRY HWY STE 100A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-2764
Practice Address - Country:US
Practice Address - Phone:813-767-3384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11010164207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty