Healthcare Provider Details

I. General information

NPI: 1750719175
Provider Name (Legal Business Name): JONATHAN GEBHART ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2013
Last Update Date: 09/21/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 LAKE ELLENOR DR STE 700
ORLANDO FL
32809-4643
US

IV. Provider business mailing address

1121 N CENTRAL AVE SUITE B
KISSIMMEE FL
34741-4405
US

V. Phone/Fax

Practice location:
  • Phone: 407-352-2542
  • Fax: 407-352-2547
Mailing address:
  • Phone: 407-933-1221
  • Fax: 407-933-5613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9294342
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: