Individual
JACKIE L CORRERO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
8060 WOLF RIVER BLVD, GERMANTOWN, TN 38138-1727
(901) 271-1000
(901) 271-4187
Mailing address
8060 WOLF RIVER BLVD, GERMANTOWN, TN 38138-1727
(901) 271-1000
(901) 271-4187
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R871348
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1309514
AANP
MS
01
—
R871348
LICENSE
MS
Enumeration date
08/19/2014
Last updated
08/19/2014
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