Provider Demographics
NPI:1235512401
Name:COBB, GREGORY MATTHEW (ARNP)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:MATTHEW
Last Name:COBB
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 1:10250 SE 167TH PLACE RD
Mailing Address - Street 2:STE 5-3
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491-8686
Mailing Address - Country:US
Mailing Address - Phone:352-322-0534
Mailing Address - Fax:
Practice Address - Street 1:10567 N CIRCLE M AVE
Practice Address - Street 2:
Practice Address - City:DUNNELLON
Practice Address - State:FL
Practice Address - Zip Code:34433-2806
Practice Address - Country:US
Practice Address - Phone:352-322-0534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9165577363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily