Provider Demographics
NPI:1457106296
Name:CORNICK, LASHAWN S
Entity Type:Individual
Prefix:
First Name:LASHAWN
Middle Name:S
Last Name:CORNICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5318 NW 12TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34482-5107
Mailing Address - Country:US
Mailing Address - Phone:352-763-1151
Mailing Address - Fax:
Practice Address - Street 1:5318 NW 12TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34482-5107
Practice Address - Country:US
Practice Address - Phone:352-763-1151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide