Healthcare Provider Details

I. General information

NPI: 1285789982
Provider Name (Legal Business Name): CECILIA M CORRADO FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CECILIA CZERWINSKE CORRADO

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11291 COUNTY LINE RD
SPRING HILL FL
34609-5616
US

IV. Provider business mailing address

3830 S HIGHWAY A1A STE 4 PMB 139
MELBOURNE BEACH FL
32951-3159
US

V. Phone/Fax

Practice location:
  • Phone: 321-917-2042
  • Fax: 334-560-1469
Mailing address:
  • Phone: 321-917-2042
  • Fax: 334-560-1469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License NumberARNP9192087
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9192087
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: