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General NPI Number Information
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NPI Number | 1265259360
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Entity Type | Individual
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Provider Name | CELIA EVAN CORREA MSN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 09/21/2024
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 7666 CHARLOTTE HWY STE 120
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City | INDIAN LAND
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State | SC
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Zip | 29707-7003
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Country | US
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Telephone | 822-080-3431
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Fax |
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Provider Business Mailing Address
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Address Line | 7776 CHARLOTTE HWY SUITE 120
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City | FORT MILL
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State | SC
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Zip | 29707
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Country | US
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Telephone | 803-431-8220
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 279666
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 29398
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 274131
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License Number State | TN
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