Provider Demographics
NPI:1932456423
Name:CORRALES, JOSSUE (ARNP, MSN, NP-C)
Entity Type:Individual
Prefix:
First Name:JOSSUE
Middle Name:
Last Name:CORRALES
Suffix:
Gender:M
Credentials:ARNP, MSN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5605 NW 82ND AVE
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-4000
Mailing Address - Country:US
Mailing Address - Phone:305-685-5688
Mailing Address - Fax:786-618-5307
Practice Address - Street 1:4888 NW 183RD ST STE 101
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-2939
Practice Address - Country:US
Practice Address - Phone:305-685-5688
Practice Address - Fax:305-623-9459
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-14
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL9310329363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL011847100Medicaid