MEDICARE: ERIC GANCEDO

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	363LF0000X	Family Nurse Practitioner	ARNP9383141	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588037253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC GANCEDO

Provider Business Mailing Address
First Line	:	4125 S TAMIAMI TRL STE 2
Second Line	:
City	:	VENICE
State	:	FL
Zip	:	34293-5121
Country	:	US
Telephone Number	:	941-584-9201
Fax Number	:	941-584-9202

Provider Business Practice Location Address
First Line	:	4125 S TAMIAMI TRL STE 2
Second Line	:
City	:	VENICE
State	:	FL
Zip	:	34293-5121
Country	:	US
Telephone Number	:	941-584-9201
Fax Number	:	941-584-9202

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

Provider Enumeration Date	:	11/03/2015
Last Update Date	:	03/25/2026

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Directions to “ ERIC GANCEDO ” Practice Location

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