Provider Demographics
NPI:1770826505
Name:CORONA, MARISOL (FNP-C)
Entity Type:Individual
Prefix:
First Name:MARISOL
Middle Name:
Last Name:CORONA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4424 E WINTERGREEN RD
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-2646
Mailing Address - Country:US
Mailing Address - Phone:520-840-2673
Mailing Address - Fax:
Practice Address - Street 1:1800 UNSER BLVD NW STE 500
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-4353
Practice Address - Country:US
Practice Address - Phone:505-205-1271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-29
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN177974163W00000X
AZ254396363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse