Individual
MRS. CORNELIA M. MCCULLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
1255 LILA ST, UFJAX - LEM TURNER FAMILY MEDICINE, JACKSONVILLE, FL 32208-3550
(904) 383-1001
(904) 244-5791
Mailing address
PO BOX 44008, UFJP - PROVIDER ENROLLMENT, JACKSONVILLE, FL 32231-4008
(904) 244-3199
(904) 244-3425
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
ARNP3228512
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0020486-00
—
FL
Enumeration date
11/12/2008
Last updated
05/26/2010
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