Provider Demographics
NPI:1689412660
Name:FERRANTE-GENNARO, GENESIS
Entity type:Individual
Prefix:
First Name:GENESIS
Middle Name:
Last Name:FERRANTE-GENNARO
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 1:2802 KIMBERLY LN
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-4508
Mailing Address - Country:US
Mailing Address - Phone:813-415-4610
Mailing Address - Fax:
Practice Address - Street 1:2802 KIMBERLY LN
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-4508
Practice Address - Country:US
Practice Address - Phone:813-415-4610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program