MEDICARE: GINA CORSANICO ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	9328917	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01519186	OTHER	FL	R&R MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467841577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA CORSANICO ARNP

Provider Business Mailing Address
First Line	:	10920 MCKINLEY DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612-6471
Country	:	US
Telephone Number	:	813-745-8414
Fax Number	:	813-449-6932

Provider Business Practice Location Address
First Line	:	10920 MCKINLEY DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612-6471
Country	:	US
Telephone Number	:	813-745-8414
Fax Number	:	813-449-6932

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2015
Last Update Date	:	09/16/2020

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