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General NPI Number Information
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NPI Number | 1023148244
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Entity Type | Individual
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Provider Name | JANINE K CORNELIUS DDS
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Gender | Female
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 3317 W MULLEN AVE
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City | TAMPA
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State | FL
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Zip | 33609-4657
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Country | US
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Telephone | 813-382-4630
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Fax |
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Provider Business Mailing Address
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Address Line | 3317 W MULLEN AVE
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City | TAMPA
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State | FL
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Zip | 33609-4657
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Country | US
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Telephone | 813-382-4630
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 12140
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DN12140
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License Number State | FL
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