Provider Demographics
NPI:1457517146
Name:CORREIA, WANDA DENISE (FNP)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:DENISE
Last Name:CORREIA
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 1:220 J L WHITE DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-4894
Mailing Address - Country:US
Mailing Address - Phone:706-253-3842
Mailing Address - Fax:706-253-3837
Practice Address - Street 1:220 J L WHITE DR
Practice Address - Street 2:SUITE 110
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-4894
Practice Address - Country:US
Practice Address - Phone:706-253-3842
Practice Address - Fax:706-253-3837
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN122788363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily