Provider Demographics
NPI:1023006376
Name:GENNOCRO, ERIN EDDY (ARNP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:EDDY
Last Name:GENNOCRO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:EDDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:700 8TH AVE W
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-4737
Mailing Address - Country:US
Mailing Address - Phone:941-776-4008
Mailing Address - Fax:941-845-4963
Practice Address - Street 1:12271 US HIGHWAY 301 N
Practice Address - Street 2:
Practice Address - City:PARRISH
Practice Address - State:FL
Practice Address - Zip Code:34219-8410
Practice Address - Country:US
Practice Address - Phone:941-776-4050
Practice Address - Fax:941-776-4057
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001775A363L00000X
FLARNP9343590363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007852900Medicaid