Provider Demographics
NPI:1932187408
Name:COCHRAN, GARY MICHAEL (CRNA)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:MICHAEL
Last Name:COCHRAN
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 1:3001 CRYSTAL BEACH RD
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880
Mailing Address - Country:US
Mailing Address - Phone:863-293-1647
Mailing Address - Fax:239-278-9966
Practice Address - Street 1:3325 TAMIAMI TRAIL
Practice Address - Street 2:STE 200 CENTER FOR DIGESTIVE DISEASES
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239
Practice Address - Country:US
Practice Address - Phone:941-552-3489
Practice Address - Fax:941-955-0642
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3260602367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL302710400Medicaid
FLE2646Medicare ID - Type Unspecified