Provider Demographics
NPI:1245915834
Name:CORONA ZAVALA, CARMEN (FNP-C)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:CORONA ZAVALA
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 1:301 BALLARD RD
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-7408
Mailing Address - Country:US
Mailing Address - Phone:863-991-3541
Mailing Address - Fax:
Practice Address - Street 1:5115 US HIGHWAY 27 N STE 100
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-1323
Practice Address - Country:US
Practice Address - Phone:863-385-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11027073363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily