Healthcare Provider Details

I. General information

NPI: 1386926863
Provider Name (Legal Business Name): JOANN MARIE CARREON RN, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2011
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6133 PARKWAY
CORPUS CHRISTI TX
78414-2459
US

IV. Provider business mailing address

4326 BEAVER CREEK DR
CORPUS CHRISTI TX
78413-4414
US

V. Phone/Fax

Practice location:
  • Phone: 361-881-8333
  • Fax:
Mailing address:
  • Phone: 361-549-6549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number112931
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP143979
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number757576
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: