Provider Demographics
NPI:1265893366
Name:MAYO, KORRIE PUJADAS (ARNP)
Entity type:Individual
Prefix:MS
First Name:KORRIE
Middle Name:PUJADAS
Last Name:MAYO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 PROFESSIONAL DR STE 101
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-6201
Mailing Address - Country:US
Mailing Address - Phone:904-605-3558
Mailing Address - Fax:
Practice Address - Street 1:115 PROFESSIONAL DR STE 101
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-6201
Practice Address - Country:US
Practice Address - Phone:904-605-3558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-16
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9362072363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily