Provider Demographics
NPI:1710227798
Name:GABRIC, COREY D (CRNA)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:D
Last Name:GABRIC
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 WEST COMMERCIAL BLVD.
Mailing Address - Street 2:SUITE 5
Mailing Address - City:FT. LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3320
Mailing Address - Country:US
Mailing Address - Phone:954-703-2931
Mailing Address - Fax:954-484-1651
Practice Address - Street 1:3601 W COMMERCIAL BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-3300
Practice Address - Country:US
Practice Address - Phone:954-703-2931
Practice Address - Fax:954-484-1651
Is Sole Proprietor?:No
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9259026367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered