MEDICARE: JENNIFER NICOLE CORREA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	246747	AZ

General Provider Information

NPI Number	:	1790615391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER NICOLE CORREA

Provider Business Mailing Address
First Line	:	1435 SUMMIT CIR
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-6768
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1435 SUMMIT CIR
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-6768
Country	:	US
Telephone Number	:	928-444-6046
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2026
Last Update Date	:	05/23/2026

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Directions to “ JENNIFER NICOLE CORREA ” Practice Location

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