MEDICARE: DIONNE VENNESA GENTLES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	171WH0202X	Home Modifications Contractor	FL
2	246RP1900X	Phlebotomy Technician	FL
3	376J00000X	Homemaker	FL
4	374U00000X	Home Health Aide	FL

General Provider Information

NPI Number	:	1760236194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIONNE VENNESA GENTLES

Provider Business Mailing Address
First Line	:	2821 NE 163RD ST APT 3S
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33160-4431
Country	:	US
Telephone Number	:	561-801-5614
Fax Number	:

Provider Business Practice Location Address
First Line	:	2821 NE 163RD ST APT 3S
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33160-4431
Country	:	US
Telephone Number	:	561-801-5614
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2024
Last Update Date	:	04/12/2024

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