Provider Demographics
NPI:1598547689
Name:EMBRY, CORY LYNN JR
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:LYNN
Last Name:EMBRY
Suffix:JR
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 1:3626 OLEANDER TER
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33404-1877
Mailing Address - Country:US
Mailing Address - Phone:561-524-3768
Mailing Address - Fax:
Practice Address - Street 1:3626 OLEANDER TER
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404-1877
Practice Address - Country:US
Practice Address - Phone:561-524-3768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL442448376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide