Provider Demographics
NPI:1205101250
Name:GENT, MISTI DAWN (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:MISTI
Middle Name:DAWN
Last Name:GENT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 W BROAD ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-9147
Mailing Address - Country:US
Mailing Address - Phone:972-552-3330
Mailing Address - Fax:
Practice Address - Street 1:713 W BROAD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-9147
Practice Address - Country:US
Practice Address - Phone:972-552-3330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX666545363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily