Provider Demographics
NPI:1285172072
Name:GENTRY, ISELDA (FNP-BC)
Entity type:Individual
Prefix:
First Name:ISELDA
Middle Name:
Last Name:GENTRY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2473 SUNFLOWER TER
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-8036
Mailing Address - Country:US
Mailing Address - Phone:760-419-7282
Mailing Address - Fax:760-477-2950
Practice Address - Street 1:161 THUNDER DR
Practice Address - Street 2:SUITE 212
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6016
Practice Address - Country:US
Practice Address - Phone:760-941-7309
Practice Address - Fax:760-477-2950
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA768621363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily