Healthcare Provider Details

I. General information

NPI: 1063224756
Provider Name (Legal Business Name): HOME PHYSICIANS GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2025
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12301 LAKE UNDERHILL RD STE 215
ORLANDO FL
32828-4511
US

IV. Provider business mailing address

12301 LAKE UNDERHILL RD STE 215
ORLANDO FL
32828-4511
US

V. Phone/Fax

Practice location:
  • Phone: 321-235-0692
  • Fax: 321-235-0694
Mailing address:
  • Phone: 321-235-0692
  • Fax: 321-235-0694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: GABRIEL NURIEL
Title or Position: CEO
Credential: DO
Phone: 321-235-0692