Provider Demographics
NPI:1235885021
Name:CLYNES, CORINNE (APRN)
Entity Type:Individual
Prefix:
First Name:CORINNE
Middle Name:
Last Name:CLYNES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3260 HAVILAND CT APT 103
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-1870
Mailing Address - Country:US
Mailing Address - Phone:727-458-7968
Mailing Address - Fax:
Practice Address - Street 1:5800 49TH ST N STE 208
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-2100
Practice Address - Country:US
Practice Address - Phone:389-572-3895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF02220052363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner