Provider Demographics
NPI:1245691898
Name:CORELL, OPAL (FNP-BC)
Entity type:Individual
Prefix:
First Name:OPAL
Middle Name:
Last Name:CORELL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3076 HUELL MATTHEWS HWY
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-7112
Mailing Address - Country:US
Mailing Address - Phone:434-420-3020
Mailing Address - Fax:
Practice Address - Street 1:CAREBRIDGE MEDICAL GROUP
Practice Address - Street 2:926 MAIN STREET
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37206
Practice Address - Country:US
Practice Address - Phone:615-436-9060
Practice Address - Fax:615-235-9725
Is Sole Proprietor?:No
Enumeration Date:2016-03-10
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC500015429363LF0000X
TN35850363LF0000X
FLAPRN11029676363LF0000X
OH0035917363LF0000X
GANP002036363LF0000X
MDAC006338363LF0000X
TX1153191363LF0000X
NC5020067363LF0000X
SC28212363LF0000X
VA0024173337363LF0000X
NV875857363LF0000X
NY353978363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily