Provider Demographics
NPI:1053039784
Name:HAYNES, CORDELIA (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:CORDELIA
Middle Name:
Last Name:HAYNES
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MRS
Other - First Name:CORI
Other - Middle Name:
Other - Last Name:HAYNES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7580 BUCKINGHAM BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-3210
Mailing Address - Country:US
Mailing Address - Phone:410-729-5100
Mailing Address - Fax:
Practice Address - Street 1:4201 MITCHELLVILLE RD STE 102
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-3175
Practice Address - Country:US
Practice Address - Phone:301-262-5900
Practice Address - Fax:410-741-0865
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2022010576363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily