Healthcare Provider Details

I. General information

NPI: 1538081344
Provider Name (Legal Business Name): JENNA MORRISA CORONA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 PAVILION WAY
SOUTHERN PINES NC
28387-4556
US

IV. Provider business mailing address

83 PITCH PINE CT
SANFORD NC
27332-2545
US

V. Phone/Fax

Practice location:
  • Phone: 910-692-2444
  • Fax:
Mailing address:
  • Phone: 910-527-4828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5025043
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: