Provider Demographics
NPI:1932758422
Name:WOMACK, CODY GUNNER (ARNP)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:GUNNER
Last Name:WOMACK
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 1:3581 SW ARCHER RD STE 40
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-2428
Mailing Address - Country:US
Mailing Address - Phone:904-900-5436
Mailing Address - Fax:
Practice Address - Street 1:3581 SW ARCHER RD STE 40
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-2428
Practice Address - Country:US
Practice Address - Phone:358-140-3260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-06
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11003963363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily