Active NPI
Mary Carmen Cornejo, APRN-BC
- Family Nurse Practitioner
- Sebring, FL
National Provider Identifier
1073233979
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 11021637
- Practice address
- 3735 Sparta Rd
Sebring, FL 33870-6066 - Phone
- (863) 449-7908
- NPI assigned
- Aug 31, 2022
- Last updated
- Aug 31, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 11021637 | FL | Primary |
Addresses
Primary practice location
3735 Sparta Rd
Sebring, FL 33870-6066
Mailing address
3735 Sparta Rd
Sebring, FL 33870-6066
Phone (863) 449-7908
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230324002442 | FL | Order and Referring Only - Nurse Practitioner | 6002280435 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11021637 | FL | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1661904000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1661904000000",
"number": "1073233979",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3735 SPARTA RD",
"city": "SEBRING",
"state": "FL",
"postal_code": "338706066",
"telephone_number": "863-449-7908"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3735 SPARTA RD",
"city": "SEBRING",
"state": "FL",
"postal_code": "338706066",
"telephone_number": "863-449-7908"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORNEJO",
"first_name": "MARY",
"middle_name": "CARMEN",
"credential": "APRN-BC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-08-31",
"last_updated": "2022-08-31",
"certification_date": "2022-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "FL",
"license": "11021637",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sebring, FL
- Cora Health Services Inc (CORA Physical Therapy - Sebring)
- Cora Health Services, Inc. (CORA Physical Therapy - South Sebring)
- Breana Cordero, FNP-C
- Andres Cordoba, MD
- Corey Henderson NP, Inc
- Cornerstone Caregiving East LLC
- Dublain Coulanges
- James Robert Crawford, MSW, LCSW
- Mark E Crawford, PTA
- Brandy L Crockett, RBT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.