Healthcare Provider Details

I. General information

NPI: 1558648576
Provider Name (Legal Business Name): CORINNE R INGLE ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2011
Last Update Date: 07/11/2021
Certification Date: 07/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2858 SUNSET BLVD
WEST COLUMBIA SC
29169-3420
US

IV. Provider business mailing address

2858 SUNSET BLVD
WEST COLUMBIA SC
29169-3420
US

V. Phone/Fax

Practice location:
  • Phone: 803-699-9073
  • Fax: 866-527-0937
Mailing address:
  • Phone: 803-699-9073
  • Fax: 803-764-2361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5005404
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: