MEDICARE: JACOB GISSY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	ME167970	FL

General Provider Information

NPI Number	:	1366805392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB GISSY MD

Provider Business Mailing Address
First Line	:	1106 PALMER AVE
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32789-2661
Country	:	US
Telephone Number	:	407-375-3857
Fax Number	:

Provider Business Practice Location Address
First Line	:	1106 PALMER AVE
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32789-2661
Country	:	US
Telephone Number	:	407-375-3857
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2016
Last Update Date	:	02/18/2026

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