MEDICARE: GABRIELLA MARIE CORCHUELO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	RN9567219	FL
2	163WC0200X	Critical Care Medicine Registered Nurse	RN9567219	FL

General Provider Information

NPI Number	:	1225964570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELLA MARIE CORCHUELO

Provider Business Mailing Address
First Line	:	13847 SACHS AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32827-7509
Country	:	US
Telephone Number	:	407-341-7603
Fax Number	:

Provider Business Practice Location Address
First Line	:	52 UNDERWOOD ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32806-1110
Country	:	US
Telephone Number	:	321-841-5111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2026
Last Update Date	:	06/23/2026

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