Healthcare Provider Details

I. General information

NPI: 1477583631
Provider Name (Legal Business Name): MICHELLE JOI CORNELL N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1417 E CONCORD ST
ORLANDO FL
32803-5409
US

IV. Provider business mailing address

1417 E CONCORD ST
ORLANDO FL
32803-5409
US

V. Phone/Fax

Practice location:
  • Phone: 407-936-2785
  • Fax: 407-936-2792
Mailing address:
  • Phone: 407-936-2785
  • Fax: 407-936-2792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberARNP 9258132
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: