Provider Demographics
NPI:1366985095
Name:KENTY, TONISHA (LPN)
Entity type:Individual
Prefix:MRS
First Name:TONISHA
Middle Name:
Last Name:KENTY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 SIKES DR
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539-3208
Mailing Address - Country:US
Mailing Address - Phone:850-972-9248
Mailing Address - Fax:
Practice Address - Street 1:121 SIKES DR
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-3208
Practice Address - Country:US
Practice Address - Phone:850-972-9248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker