Healthcare Provider Details

I. General information

NPI: 1336949031
Provider Name (Legal Business Name): TARA MICHELLE CORNETT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 03/13/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 WEST 8TH STREET TOWER 1 /SUITE 505
JACKSONVILLE FL
32209
US

IV. Provider business mailing address

1547 ISLAND BREEZE PT
FLEMING ISLAND FL
32003-4841
US

V. Phone/Fax

Practice location:
  • Phone: 904-244-9571
  • Fax:
Mailing address:
  • Phone: 904-338-7287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License NumberAPRN9363891
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: