Individual
AGATHA GENTRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
520 W LAKE MARY BLVD STE 214, SANFORD, FL 32773-7424
(800) 614-4124
Mailing address
8500 RIDGEWOOD AVE APT 505, CAPE CANAVERAL, FL 32920-2148
(407) 408-3059
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
9250702
FL
Other
Enumeration date
09/19/2017
Last updated
09/19/2017
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