Healthcare Provider Details

I. General information

NPI: 1760207310
Provider Name (Legal Business Name): JOAN Z CORNIER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 SQUIRREL TRL
LONGWOOD FL
32779-3412
US

IV. Provider business mailing address

202 SQUIRREL TRL
LONGWOOD FL
32779-3412
US

V. Phone/Fax

Practice location:
  • Phone: 321-287-1842
  • Fax:
Mailing address:
  • Phone: 321-287-1842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: MRS. JOAN Z CORNIER
Title or Position: REGISTERED DIETITIAN
Credential: RD, LD, CDCES
Phone: 321-287-1842