Healthcare Provider Details

I. General information

NPI: 1275412041
Provider Name (Legal Business Name): VERONICA GEMA PELLINO FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1667 N CLYDE MORRIS BLVD STE 2
DAYTONA BEACH FL
32117-5500
US

IV. Provider business mailing address

812 BAYLOR DR
DELTONA FL
32725-7000
US

V. Phone/Fax

Practice location:
  • Phone: 386-518-6401
  • Fax: 386-274-2215
Mailing address:
  • Phone: 386-479-7966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11041931
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: