Provider Demographics
NPI:1578084174
Name:GENT, SAMANTHA NICOLE (CNA)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:NICOLE
Last Name:GENT
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 HIGHWAY 113
Mailing Address - Street 2:
Mailing Address - City:WHITESBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37891-2213
Mailing Address - Country:US
Mailing Address - Phone:423-307-0089
Mailing Address - Fax:
Practice Address - Street 1:620 DAVIS DR
Practice Address - Street 2:
Practice Address - City:NEW TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37825-2152
Practice Address - Country:US
Practice Address - Phone:423-626-4291
Practice Address - Fax:423-626-2525
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-05
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00173136376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide