Provider Demographics
NPI:1295912996
Name:PETRINO, LAYNE K (NNP)
Entity type:Individual
Prefix:MRS
First Name:LAYNE
Middle Name:K
Last Name:PETRINO
Suffix:
Gender:
Credentials:NNP
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:LAYNE
Other - Last Name:KORNICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NNP
Mailing Address - Street 1:380 RINEHART RD
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2551
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:380 RINEHART RD
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2551
Practice Address - Country:US
Practice Address - Phone:407-767-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-24
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9237035363LN0000X, 363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
No363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA039256068BMedicaid
FL0004354-00Medicaid
FLCT665ZMedicare PIN