Individual provider Active NPI

Warren Leck Gabrillo VI, NP-C

  • Family Nurse Practitioner
  • Jacksonville, FL
National Provider Identifier
1902649395
Registry record updated Jul 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
11032711 Issued in FL
Practice address
9310 Old Kings Rd S Ste 1303
Jacksonville, FL 32257-8100
Phone
(904) 900-3472
Fax
(900) 503-2373
NPI assigned
Jun 14, 2024
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 29, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 11032711 FL Primary

Addresses

Primary practice location

9310 Old Kings Rd S Ste 1303
Jacksonville, FL 32257-8100

Mailing address

9310 Old Kings Rd S Ste 1303
Jacksonville, FL 32257-8100
Phone (904) 900-3472

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260416001228 FL Practitioner - Nurse Practitioner 8022584127 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Upperline Healthcare PCGroup PAC ID 4385900653, 194 clinicians

Practice addresses (Care Compare)

240 Ponte Vedra Park Dr
Suite 150
Ponte Vedra Beach, FL 32082-6612
Phone (904) 223-8818

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11032711FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Cornerstone Family Medicine LLC CurrentSince Aug 3, 2025 Accepting new patients

Locations

9310 Old Kings Rd S
Ste 1303
Jacksonville, FL 32257
Phone (904) 900-3472

Interoperability endpoints

  • FHIR API: https://fhir.fhirpoint.open.allscripts.com/fhirroute/open/10036363

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1718323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753747200000",
    "number": "1902649395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9310 OLD KINGS RD S STE 1303",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322578100",
            "telephone_number": "904-900-3472",
            "fax_number": "904-503-2373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9310 OLD KINGS RD S STE 1303",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322578100",
            "telephone_number": "904-900-3472",
            "fax_number": "900-503-2373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GABRILLO",
        "first_name": "WARREN LECK",
        "name_suffix": "VI",
        "credential": "NP-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-06-14",
        "last_updated": "2025-07-29",
        "certification_date": "2025-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11032711",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.