MEDICARE: CORY GERBRANDT

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	172A00000X	Driver	G616114770060	FL

General Provider Information

NPI Number	:	1639990112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORY GERBRANDT

Provider Business Mailing Address
First Line	:	3613 MORSE CT
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32309-3248
Country	:	US
Telephone Number	:	239-207-8580
Fax Number	:

Provider Business Practice Location Address
First Line	:	3613 MORSE CT
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32309-3248
Country	:	US
Telephone Number	:	239-207-8580
Fax Number	:

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

Provider Enumeration Date	:	10/18/2024
Last Update Date	:	02/19/2025

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Directions to “ CORY GERBRANDT ” Practice Location

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