Provider Demographics
NPI:1982374468
Name:CORNEILLE MEDICAL TRAINING & CONSULTING
Entity Type:Organization
Organization Name:CORNEILLE MEDICAL TRAINING & CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KETURAH
Authorized Official - Middle Name:JAROMYRE
Authorized Official - Last Name:CORNEILLE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:407-922-3570
Mailing Address - Street 1:6100 LAKE ELLENOR DR STE 300
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-4638
Mailing Address - Country:US
Mailing Address - Phone:407-358-6640
Mailing Address - Fax:
Practice Address - Street 1:6100 LAKE ELLENOR DR STE 300
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-4638
Practice Address - Country:US
Practice Address - Phone:407-358-6640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-16
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No251300000XAgenciesLocal Education Agency (LEA)
No251E00000XAgenciesHome Health
No251K00000XAgenciesPublic Health or Welfare
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No305S00000XManaged Care OrganizationsPoint of Service