Provider Demographics
NPI:1780109553
Name:CORRALES, JENNIFER ANNE (AG-ACNP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANNE
Last Name:CORRALES
Suffix:
Gender:F
Credentials:AG-ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6124 W PARKER RD STE 536
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8137
Mailing Address - Country:US
Mailing Address - Phone:972-378-9560
Mailing Address - Fax:844-290-4363
Practice Address - Street 1:6124 W PARKER RD STE 536
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8137
Practice Address - Country:US
Practice Address - Phone:972-378-9560
Practice Address - Fax:844-290-4363
Is Sole Proprietor?:No
Enumeration Date:2017-08-13
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134788363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care