Provider Demographics
NPI:1679240253
Name:CORREA, MICHELLE D (DNP, FNP-BC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:D
Last Name:CORREA
Suffix:
Gender:
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:CORREA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:6242 E ARBOR AVE STE 118
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-1309
Mailing Address - Country:US
Mailing Address - Phone:602-805-4914
Mailing Address - Fax:602-805-4917
Practice Address - Street 1:6242 E ARBOR AVE STE 118
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1309
Practice Address - Country:US
Practice Address - Phone:602-805-4914
Practice Address - Fax:602-805-4917
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ242247363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ242247OtherRN
AZ169321Medicaid