MEDICARE: GABRIELLE DEMI PETRILLI APRN

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	363LF0000X	Family Nurse Practitioner	11048540	FL

General Provider Information

NPI Number	:	1710813647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELLE DEMI PETRILLI APRN

Provider Business Mailing Address
First Line	:	617 SPRINGVIEW DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-6931
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2187 HOWLAND BLVD
Second Line	:
City	:	DELTONA
State	:	FL
Zip	:	32738-3441
Country	:	US
Telephone Number	:	386-789-0813
Fax Number	:

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

Provider Enumeration Date	:	06/19/2026
Last Update Date	:	06/19/2026

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