Provider Demographics
NPI:1235961673
Name:WENTWORTH, GINA (RDMS)
Entity type:Individual
Prefix:MS
First Name:GINA
Middle Name:
Last Name:WENTWORTH
Suffix:
Gender:F
Credentials:RDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3195 GRAND AVE APT 404
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782-6133
Mailing Address - Country:US
Mailing Address - Phone:727-600-4259
Mailing Address - Fax:
Practice Address - Street 1:558 94TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-2406
Practice Address - Country:US
Practice Address - Phone:727-600-4259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL943822085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound