Provider Demographics
NPI:1790083988
Name:CORNIER, JOAN Z (RD, LDN)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:Z
Last Name:CORNIER
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 SQUIRREL TRL
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-3412
Mailing Address - Country:US
Mailing Address - Phone:321-287-1842
Mailing Address - Fax:
Practice Address - Street 1:202 SQUIRREL TRL
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-3412
Practice Address - Country:US
Practice Address - Phone:321-287-1842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-11
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND3103133VN1006X
FLND 3103133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered