Provider Demographics
NPI:1639806912
Name:GENTILE, AUDREY L (NP)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:L
Last Name:GENTILE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:L
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2429 S PRAIRIE AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-2886
Mailing Address - Country:US
Mailing Address - Phone:719-564-5070
Mailing Address - Fax:719-896-2874
Practice Address - Street 1:2429 S PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-2886
Practice Address - Country:US
Practice Address - Phone:719-564-5070
Practice Address - Fax:719-896-2874
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0997843.NP363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology