Provider Demographics
NPI:1275428369
Name:GENTILE, JESSANN ROSE
Entity type:Individual
Prefix:
First Name:JESSANN
Middle Name:ROSE
Last Name:GENTILE
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 1:189 SEA COTTON CIR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-8296
Mailing Address - Country:US
Mailing Address - Phone:843-534-7050
Mailing Address - Fax:
Practice Address - Street 1:189 SEA COTTON CIR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-8296
Practice Address - Country:US
Practice Address - Phone:843-795-4630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program