Provider Demographics
NPI:1811779994
Name:CORREA, NICOLASA (PHD, DAHN, DFM, DTN)
Entity type:Individual
Prefix:
First Name:NICOLASA
Middle Name:
Last Name:CORREA
Suffix:
Gender:F
Credentials:PHD, DAHN, DFM, DTN
Other - Prefix:
Other - First Name:NYSSA
Other - Middle Name:
Other - Last Name:CORREA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, DAHN, DFM, DTN
Mailing Address - Street 1:1250 SAVANNAH HWY
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:GA
Mailing Address - Zip Code:30467-1002
Mailing Address - Country:US
Mailing Address - Phone:912-541-5019
Mailing Address - Fax:
Practice Address - Street 1:1250 SAVANNAH HWY
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:GA
Practice Address - Zip Code:30467-1002
Practice Address - Country:US
Practice Address - Phone:912-541-5019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171400000XOther Service ProvidersHealth & Wellness Coach
No173C00000XOther Service ProvidersReflexologist
No175L00000XOther Service ProvidersHomeopath
No246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
1231093282OtherNASM