Healthcare Provider Details

I. General information

NPI: 1174206635
Provider Name (Legal Business Name): CORAZON SELINA ACQUINO OKODE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2023
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 MILL ST
HAGERSTOWN MD
21740-6138
US

IV. Provider business mailing address

19007 MT. MAPLE COURT
HAGERSTOWN MD
21742
US

V. Phone/Fax

Practice location:
  • Phone: 301-739-6620
  • Fax:
Mailing address:
  • Phone: 301-613-6738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR219783
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: