Provider Demographics
NPI:1407359276
Name:CORMIER, JOHN RAYMOND III (AP, RN)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:RAYMOND
Last Name:CORMIER
Suffix:III
Gender:M
Credentials:AP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 SW INFINITY PL
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32024-5378
Mailing Address - Country:US
Mailing Address - Phone:386-628-1088
Mailing Address - Fax:
Practice Address - Street 1:1009 SW MAIN BLVD STE 110
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-5784
Practice Address - Country:US
Practice Address - Phone:386-628-1088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3390372163WE0003X
FL3926171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No163WE0003XNursing Service ProvidersRegistered NurseEmergency