Provider Demographics
NPI:1891438149
Name:CORDERO, LYNNET EVE (PA)
Entity Type:Individual
Prefix:DR
First Name:LYNNET
Middle Name:EVE
Last Name:CORDERO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 ATLANTIC DR
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33570-4911
Mailing Address - Country:US
Mailing Address - Phone:813-535-2550
Mailing Address - Fax:
Practice Address - Street 1:104B CALLE MARCOS LOPEZ
Practice Address - Street 2:
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693-5068
Practice Address - Country:US
Practice Address - Phone:813-535-2550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR718363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant