Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RE0101X | Endocrinologist (Diabetes Doctor) | APRN11004578 | FL |
Y | 363L00000X | Nurse Practitioner | APRN11004578 | FL |
NPI | 1053605485 |
---|---|
Provider Name | Joann Cornejo |
First Address | Miami, FL 33143 |
Second Address | South Miami, FL 33143-5026 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2011 |
Last Update Date | 19/05/2021 |