Provider Demographics
NPI:1023016854
Name:GENTZ, AIMEE L (NP)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:L
Last Name:GENTZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 GLENDALE AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2426
Mailing Address - Country:US
Mailing Address - Phone:567-420-1600
Mailing Address - Fax:567-420-1635
Practice Address - Street 1:2100 W CENTRAL AVE FL 2
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606
Practice Address - Country:US
Practice Address - Phone:567-420-1600
Practice Address - Fax:567-420-1635
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH06554363L00000X
OHAPRN.CNP.06554363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2327191Medicaid
MI4440534Medicaid
OH344428156103OtherCARESOURCE
MI4440534Medicaid
OH76621Medicare PIN
OH2327191Medicaid