Provider Demographics
NPI:1780999292
Name:RENTAS, DENISE
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:RENTAS
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 1:400 FRANDORSON CIR STE 103
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-2688
Mailing Address - Country:US
Mailing Address - Phone:813-641-3565
Mailing Address - Fax:813-641-3560
Practice Address - Street 1:400 FRANDORSON CIR STE 103
Practice Address - Street 2:
Practice Address - City:APOLLO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33572-2688
Practice Address - Country:US
Practice Address - Phone:813-641-3565
Practice Address - Fax:813-641-3560
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001934500Medicaid