Provider Demographics
NPI:1902992787
Name:GENTLES, CHARMAINE V (ANP)
Entity Type:Individual
Prefix:
First Name:CHARMAINE
Middle Name:V
Last Name:GENTLES
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:CHARMAINE
Other - Middle Name:V
Other - Last Name:GENTLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP
Mailing Address - Street 1:122 HAMILTON RD
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-4637
Mailing Address - Country:US
Mailing Address - Phone:516-562-4852
Mailing Address - Fax:
Practice Address - Street 1:300 COMMUNITY DRIVE
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030
Practice Address - Country:US
Practice Address - Phone:516-562-4852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2006003540363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health