Provider Demographics
NPI:1730144700
Name:GENTILE, JANICE ELAINE
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:ELAINE
Last Name:GENTILE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4231 AUDUBON OAKS CIR
Mailing Address - Street 2:#105
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-5938
Mailing Address - Country:US
Mailing Address - Phone:863-409-0527
Mailing Address - Fax:
Practice Address - Street 1:1131 US HIGHWAY 98 S
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-5949
Practice Address - Country:US
Practice Address - Phone:863-687-4540
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 2160171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist