Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Gavin Villacorta, CRNP

Individual provider Nurse Practitioner · NPI 1093411688

Gavin Villacorta, CRNP is a Nurse Practitioner in Philadelphia, Pennsylvania. Qualified in 2022, 4 years ago. Practices with University of Penn-Medical Group, a 3,401-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Pennsylvania.

Years since qualifying
4
Licensed in
PA
In the registry since
2023
What do these letters mean?
CRNP — Certified Registered Nurse Practitioner
The title Pennsylvania and some other states use for a nurse practitioner.

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Practice location Address checks out

330 S 9th St
Philadelphia, PA 19107-6103
Phone: (215) 829-6500
Fax: (215) 829-6606
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence SP027036 (PA)

Record details

NPI number1093411688
Entity typeIndividual (Type 1)
GenderMale
Credentials CRNP
Sole proprietorNo
NPI enumeratedFebruary 6, 2023
Last updated in NPPESFebruary 6, 2023
Certification dateFebruary 4, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice University Of Penn-Medical Group — 3401 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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