Provider Demographics
NPI:1588654792
Name:GENTLES, CAROLYN ANN (FNP)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:ANN
Last Name:GENTLES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:ANN
Other - Middle Name:
Other - Last Name:GENTLES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:345 FRESHFIELDS DR STE J101
Practice Address - Street 2:
Practice Address - City:JOHNS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455-5443
Practice Address - Country:US
Practice Address - Phone:843-768-4800
Practice Address - Fax:843-606-8039
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18178363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC18178OtherLICENSE
SCNP2993Medicaid