Healthcare Provider Details

I. General information

NPI: 1619954260
Provider Name (Legal Business Name): NANCY ANN CORNETT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS NANCY ANN KING

II. Dates (important events)

Enumeration Date: 12/26/2005
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2830 BEE RIDGE RD
SARASOTA FL
34239-7115
US

IV. Provider business mailing address

6370 MIDNIGHT COVE RD
SARASOTA FL
34242-3453
US

V. Phone/Fax

Practice location:
  • Phone: 941-927-1234
  • Fax: 941-921-0043
Mailing address:
  • Phone: 310-614-1212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9102674
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: