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General NPI Number Information
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NPI Number | 1811700321
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Entity Type | Organization
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Legal Business Name | IVAN CORREDERA LLC
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Dates
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Enumeration Date | 01/29/2025
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 1825 FOREST HILL BLVD STE 204
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City | WEST PALM BEACH
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State | FL
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Zip | 33406-6062
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Country | US
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Telephone | 561-264-2970
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Fax |
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Provider Business Mailing Address
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Address Line | 1072 JASON WAY
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City | WEST PALM BEACH
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State | FL
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Zip | 33406-5253
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Country | US
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Telephone | 561-502-3847
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | IVAN CORREDERA
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Credential | NP
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Telephone | 561-502-3847
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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