Provider Demographics
NPI:1871847939
Name:GENTLES, ISIS SERENA (HTL)
Entity Type:Individual
Prefix:MRS
First Name:ISIS
Middle Name:SERENA
Last Name:GENTLES
Suffix:
Gender:F
Credentials:HTL
Other - Prefix:MISS
Other - First Name:ISIS
Other - Middle Name:SERENA
Other - Last Name:ADDARICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9272 SWEET MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-5668
Mailing Address - Country:US
Mailing Address - Phone:321-332-5979
Mailing Address - Fax:
Practice Address - Street 1:5201 RAYMOND ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-8208
Practice Address - Country:US
Practice Address - Phone:407-629-1599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-28
Last Update Date:2012-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTN41299246QH0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QH0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyHistology