Healthcare Provider Details

I. General information

NPI: 1487659421
Provider Name (Legal Business Name): PETER CORRENTI JR. DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16966 CAGAN RIDGE BLVD STE 200
CLERMONT FL
34714-9656
US

IV. Provider business mailing address

16966 CAGAN RIDGE BLVD STE 200
CLERMONT FL
34714-9656
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-6444
  • Fax: 407-290-2118
Mailing address:
  • Phone: 321-841-6444
  • Fax: 407-290-2118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberOS20057
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberOS006539L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: