Provider Demographics
NPI:1285789982
Name:CORRADO, CECILIA M (FNP-BC)
Entity type:Individual
Prefix:
First Name:CECILIA
Middle Name:M
Last Name:CORRADO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:CECILIA
Other - Middle Name:CZERWINSKE
Other - Last Name:CORRADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3830 S HIGHWAY A1A STE 4 PMB 139
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32951-3159
Mailing Address - Country:US
Mailing Address - Phone:321-917-2042
Mailing Address - Fax:334-560-1469
Practice Address - Street 1:11291 COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-5616
Practice Address - Country:US
Practice Address - Phone:321-917-2042
Practice Address - Fax:334-560-1469
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP91920872084B0040X
FL9192087363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & Neuropsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006776001Medicaid
FL114479100Medicaid