Provider Demographics
NPI:1467841577
Name:CORSANICO, GINA (ARNP)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:CORSANICO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10920 MCKINLEY DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-6471
Mailing Address - Country:US
Mailing Address - Phone:813-745-8414
Mailing Address - Fax:813-449-6932
Practice Address - Street 1:10920 MCKINLEY DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-6471
Practice Address - Country:US
Practice Address - Phone:813-745-8414
Practice Address - Fax:813-449-6932
Is Sole Proprietor?:No
Enumeration Date:2015-01-13
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9328917363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01519186OtherR&R MEDICARE
FL014828300Medicaid
FLP01519186OtherR&R MEDICARE