Provider Demographics
NPI:1760236194
Name:GENTLES, DIONNE VENNESA
Entity Type:Individual
Prefix:
First Name:DIONNE
Middle Name:VENNESA
Last Name:GENTLES
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 1:2821 NE 163RD ST APT 3S
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-4431
Mailing Address - Country:US
Mailing Address - Phone:561-801-5614
Mailing Address - Fax:
Practice Address - Street 1:2821 NE 163RD ST APT 3S
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-4431
Practice Address - Country:US
Practice Address - Phone:561-801-5614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171WH0202X, 246RP1900X, 376J00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No171WH0202XOther Service ProvidersContractorHome Modifications
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No376J00000XNursing Service Related ProvidersHomemaker