Healthcare Provider Details

I. General information

NPI: 1205903432
Provider Name (Legal Business Name): PRIMARY CARE OF CENTRAL FLORIDA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
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 TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

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