Provider Demographics
NPI:1366450389
Name:CORNELIUS, JEFFREY S (CRNP)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
Last Name:CORNELIUS
Suffix:
Gender:M
Credentials:CRNP
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:421 WEST COLLEGE ST
Mailing Address - Street 2:INFANTS AND CHILDRENS CLINIC PC
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630
Mailing Address - Country:US
Mailing Address - Phone:256-764-9522
Mailing Address - Fax:256-764-1139
Practice Address - Street 1:421 WEST COLLEGE ST
Practice Address - Street 2:INFANTS AND CHILDRENS CLINIC PC
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630
Practice Address - Country:US
Practice Address - Phone:256-764-9522
Practice Address - Fax:256-764-1139
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL1078351363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL891002770Medicaid
AL51093255OtherBC
AL51093255OtherBC