Healthcare Provider Details

I. General information

NPI: 1184464489
Provider Name (Legal Business Name): LIGIA MARIA COREA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2024
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1278 N LAFAYETTE DR
SUMTER SC
29150-2964
US

IV. Provider business mailing address

1237 N MATTHEWS RD
LAKE CITY SC
29560-7021
US

V. Phone/Fax

Practice location:
  • Phone: 803-774-4500
  • Fax: 803-774-4626
Mailing address:
  • Phone: 843-598-3126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28566
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: