Individual
KELLY CORNNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
305 E BRANDON BLVD, BRANDON, FL 33511-5222
(813) 978-9700
Mailing address
13020 N TELECOM PKWY, TEMPLE TERRACE, FL 33637-0925
(813) 978-9700
(813) 558-6186
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
9110185
FL
Other
Enumeration date
03/20/2017
Last updated
01/28/2020
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