Provider Demographics
NPI:1699657320
Name:SOLOMON, CORI LYNN
Entity type:Individual
Prefix:MRS
First Name:CORI
Middle Name:LYNN
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7751 BELFORT PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6921
Mailing Address - Country:US
Mailing Address - Phone:904-372-3943
Mailing Address - Fax:904-212-1618
Practice Address - Street 1:50 NY-25 A
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3448
Practice Address - Country:US
Practice Address - Phone:904-372-3943
Practice Address - Fax:904-212-1618
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-23
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF312416-01363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner