Healthcare Provider Details

I. General information

NPI: 1164042776
Provider Name (Legal Business Name): AMY JO CORREIA CCP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2020
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6598 ALVERNO LN
INVER GROVE HEIGHTS MN
55077-0700
US

IV. Provider business mailing address

6598 ALVERNO LN
INVER GROVE HEIGHTS MN
55077-0700
US

V. Phone/Fax

Practice location:
  • Phone: 651-380-6095
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code242T00000X
TaxonomyPerfusionist
License NumberFPF02000110
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: