Individual
ANGELICA MANZOLILLO CORREA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
1651 SE TIFFANY AVE, PORT ST LUCIE, FL 34952-7564
(772) 398-1800
Mailing address
1651 SE TIFFANY AVE, PORT ST LUCIE, FL 34952-7564
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
11031122
FL
363LP2300X
Primary Care Nurse Practitioner
F347464-01
NY
Other
Enumeration date
07/25/2021
Last updated
06/24/2024
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