Provider Demographics
NPI:1225538531
Name:CORNEILLIE, HENRY
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:CORNEILLIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4445 ESSEX LN
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-1822
Mailing Address - Country:US
Mailing Address - Phone:321-512-2950
Mailing Address - Fax:
Practice Address - Street 1:4445 ESSEX LN
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-1822
Practice Address - Country:US
Practice Address - Phone:321-512-2950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-14
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities