Provider Demographics
NPI:1245518976
Name:CORRADO LLC
Entity type:Organization
Organization Name:CORRADO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CORRADO
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:321-615-5560
Mailing Address - Street 1:1698 B WEST HIBISCUS BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-2639
Mailing Address - Country:US
Mailing Address - Phone:321-917-2042
Mailing Address - Fax:334-560-1469
Practice Address - Street 1:1698 B WEST HIBISCUS BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2639
Practice Address - Country:US
Practice Address - Phone:321-917-2042
Practice Address - Fax:334-560-1469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-29
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Multi-Specialty
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care MedicineGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307023900Medicaid
FL307023900Medicaid