Provider Demographics
NPI:1285987925
Name:DUNLAP GENTRY, ROSALYN (EXECUTIVE DIRECTOR)
Entity type:Individual
Prefix:
First Name:ROSALYN
Middle Name:
Last Name:DUNLAP GENTRY
Suffix:
Gender:F
Credentials:EXECUTIVE DIRECTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6123 METROWEST BLVD UNIT 116
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-2963
Mailing Address - Country:US
Mailing Address - Phone:407-703-5959
Mailing Address - Fax:
Practice Address - Street 1:901 DOUGLAS AVE STE 205
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2057
Practice Address - Country:US
Practice Address - Phone:407-703-5959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003564600Medicaid