Provider Demographics
NPI:1073816005
Name:GENTILE, NICOLE ELYSE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:ELYSE
Last Name:GENTILE
Suffix:
Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:151 SOUTHHALL LN STE 300
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7172
Mailing Address - Country:US
Mailing Address - Phone:407-875-2080
Mailing Address - Fax:407-650-3455
Practice Address - Street 1:4331 N FEDERAL HWY STE 400
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33308-5252
Practice Address - Country:US
Practice Address - Phone:954-772-0416
Practice Address - Fax:954-772-5716
Is Sole Proprietor?:No
Enumeration Date:2010-12-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9105794363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant