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General NPI Number Information
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NPI Number | 1639046345
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Entity Type | Organization
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Legal Business Name | CORCOBA FAMILY HEALTH CARE
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Dates
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Enumeration Date | 10/20/2025
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Last Update Date | 10/20/2025
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Provider Practice Location Address
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Address Line | 8390 CHAMPIONS GATE BLVD STE 108
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City | CHAMPIONS GATE
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State | FL
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Zip | 33896-8311
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Country | US
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Telephone | 863-521-4497
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Fax | 815-205-4677
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Provider Business Mailing Address
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Address Line | 8390 CHAMPIONS GATE BLVD STE 108
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City | CHAMPIONS GATE
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State | FL
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Zip | 33896-8311
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Country | US
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Telephone | 863-521-4497
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Fax | 815-205-4677
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Authorized Official
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Title or Position | OWNER
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Name | ELIZABETH LEON CORCOBA
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Credential | NURSE PACTITIONER
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Telephone | 816-682-7985
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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