Provider Demographics
NPI:1861150815
Name:CORNETT, JANICE LYNETTE (LPN)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:LYNETTE
Last Name:CORNETT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5975 FREEDOM DR
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:FL
Mailing Address - Zip Code:34736-9643
Mailing Address - Country:US
Mailing Address - Phone:740-418-0828
Mailing Address - Fax:
Practice Address - Street 1:1390 E BURLEIGH BLVD
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-4305
Practice Address - Country:US
Practice Address - Phone:740-418-0828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLA-3124671171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach