Healthcare Provider Details

I. General information

NPI: 1245266816
Provider Name (Legal Business Name): ZINA T CORNWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 03/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3819 MURRELL RD
ROCKLEDGE FL
32955-4752
US

IV. Provider business mailing address

2501 COTTONTAIL LN
SOMERSET NJ
08873-5125
US

V. Phone/Fax

Practice location:
  • Phone: 321-305-4905
  • Fax: 321-305-4908
Mailing address:
  • Phone: 732-529-7190
  • Fax: 732-568-7904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS3966
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: