Healthcare Provider Details

I. General information

NPI: 1710829890
Provider Name (Legal Business Name): BRENT COCHRAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7108 S KANNER HWY
STUART FL
34997-7462
US

IV. Provider business mailing address

13557 OLD DOCK RD
ORLANDO FL
32828-6199
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6827
  • Fax: 772-675-9100
Mailing address:
  • Phone: 407-595-5862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: