Healthcare Provider Details

I. General information

NPI: 1588654792
Provider Name (Legal Business Name): CAROLYN ANN GENTLES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANN GENTLES NP

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W FARIS RD
GREENVILLE SC
29605-4255
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 864-455-6743
  • Fax: 864-454-4669
Mailing address:
  • Phone: 864-695-6697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18178
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: