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General NPI Number Information
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NPI Number | 1336949031
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Entity Type | Individual
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Provider Name | TARA MICHELLE CORNETT APRN
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Gender | Female
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Dates
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Enumeration Date | 03/13/2025
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Last Update Date | 03/13/2025
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Provider Practice Location Address
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Address Line | 580 WEST 8TH STREET TOWER 1 /SUITE 505
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City | JACKSONVILLE
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State | FL
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Zip | 32209
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Country | US
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Telephone | 904-244-9571
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Fax |
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Provider Business Mailing Address
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Address Line | 1547 ISLAND BREEZE PT
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City | FLEMING ISLAND
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State | FL
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Zip | 32003-4841
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Country | US
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Telephone | 904-338-7287
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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 | 363LX0106X
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Taxonomy Name | Occupational Health Nurse Practitioner
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License Number | APRN9363891
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License Number State | FL
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