Provider Demographics
NPI:1740027325
Name:CHIUCO, CORINA AGUSTIN (FNP-BC, FNP-C)
Entity type:Individual
Prefix:
First Name:CORINA
Middle Name:AGUSTIN
Last Name:CHIUCO
Suffix:
Gender:F
Credentials:FNP-BC, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3019 SOFIA WAY
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95212-3553
Mailing Address - Country:US
Mailing Address - Phone:209-915-1312
Mailing Address - Fax:
Practice Address - Street 1:3019 SOFIA WAY
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95212-3553
Practice Address - Country:US
Practice Address - Phone:209-915-1312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95031064363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner