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Jennifer Marie Correa

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

200 Medical Plaza Ste 214, Los Angeles, CA 90095

PECOS Enrollment

This provider is enrolled in PECOS as JENNIFER CORREA.

Based on the most recent information from CMS, provider Jennifer Marie Correa is legally eligible to order and refer claims for DME and PMD services only.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 11 days ago.

Profile Details

Provider ID
1669774162
Provider Type
Individual
Full Name
Correa, Jennifer Marie
Title
Ms.
Credential
R.N., N.P., CNS

Gender
Female
Sole Proprietor
Yes
Enumeration Date
12/3/2010
Last Updated
7/11/2018

Contact Information

Practice Location

200 Medical Plaza Ste 214, Los Angeles, CA 90095

(310) 825-6078

Unlisted Fax

Mailing Location

5767 W Century Blvd Ste 400, Los Angeles, CA 90045-5631

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363LA2100X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 20034 California
Code 163W00000X	Description Registered Nurse Nursing Service Providers	License 437292 California
Code 364S00000X	Description Clinical Nurse Specialist Physician Assistants & Advanced Practice Nursing Providers	License 3454 California

Jennifer Marie Correa

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Code

Description

License

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