Provider Demographics
NPI:1760953871
Name:GAVIRIA-CORREA, NATHALIA ANDREA (APRN)
Entity Type:Individual
Prefix:
First Name:NATHALIA
Middle Name:ANDREA
Last Name:GAVIRIA-CORREA
Suffix:
Gender:F
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:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653-0188
Mailing Address - Country:US
Mailing Address - Phone:520-682-4111
Mailing Address - Fax:520-818-3630
Practice Address - Street 1:3690 S PARK AVE STE 805
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-5042
Practice Address - Country:US
Practice Address - Phone:520-616-6760
Practice Address - Fax:520-616-6799
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11000530363LF0000X
AZ234345363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ606645Medicaid