MEDICARE: DR. MICHAEL P GAMBACORTA FNP

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	363L00000X	Nurse Practitioner	28968	SC
2	208100000X	Physical Medicine & Rehabilitation Physician	28968	SC

General Provider Information

NPI Number	:	1851393920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL P GAMBACORTA FNP

Provider Business Mailing Address
First Line	:	100 LEGENDS RD STE A
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-7076
Country	:	US
Telephone Number	:	843-236-9090
Fax Number	:	843-236-9099

Provider Business Practice Location Address
First Line	:	100 LEGENDS RD
Second Line	:	STE A
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-7076
Country	:	US
Telephone Number	:	843-236-9090
Fax Number	:	843-236-9099

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

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	01/15/2025

Similar Medicare Providers

1962764142 — MYRTLE BEACH SPINE CENTER, PA
Practice Location Address:

100 LEGENDS RD SUITE A
MYRTLE BEACH, SC
29579-7076

Practice Phone: 843-236-9090
Practice Fax: 843-236-9099

1972589612 — ROBERT J MUNOZ P.A.
Practice Location Address:

96279 BRADY POINT RD
FERNANDINA BEACH, FL
32034-7076

Practice Phone: 904-321-0088
Practice Fax:

1912972530 — DR. DANIEL JAMES MATRICIA D.O.
Practice Location Address:

96279 BRADY POINT RD
FERNANDINA BEACH, FL
32034-7076

Practice Phone: 904-321-0088
Practice Fax: 904-321-0016

1295795896 — RANDALL B FULFORD PA-C
Practice Location Address:

96279 BRADY POINT RD
FERNANDINA BEACH, FL
32034-7076

Practice Phone: 904-321-0088
Practice Fax:

1447203948 — H2 REHABILITATION SERVICES OF FLORIDA LLC
Practice Location Address:

96279 BRADY POINT RD , SUITE B
FERNANDINA BEACH, FL
32034-7076

Practice Phone: 904-261-7878
Practice Fax: 904-261-8466

1720417884 — AMELIA URGENT CARE LLC
Practice Location Address:

96279 BRADY POINT RD
FERNANDINA BEACH, FL
32034-7076

Practice Phone: 904-321-1177
Practice Fax: 904-321-0016

Directions to “ DR. MICHAEL P GAMBACORTA FNP” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.