Provider Demographics
NPI:1144320623
Name:CULBRETH, GREGORY S (ARNP)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:S
Last Name:CULBRETH
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 628296
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32862-8296
Mailing Address - Country:US
Mailing Address - Phone:407-741-9418
Mailing Address - Fax:904-346-0113
Practice Address - Street 1:1414 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2134
Practice Address - Country:US
Practice Address - Phone:407-841-5111
Practice Address - Fax:904-346-0113
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2211412374T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE4652ZMedicare ID - Type Unspecified
FLP15023Medicare UPIN
FLE4652YMedicare PIN