Provider Demographics
NPI:1033440136
Name:GONZALEZ, LAZARO (APRN)
Entity Type:Individual
Prefix:
First Name:LAZARO
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2665 CLEVELAND AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-5884
Mailing Address - Country:US
Mailing Address - Phone:239-313-6300
Mailing Address - Fax:239-689-5524
Practice Address - Street 1:2665 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-5850
Practice Address - Country:US
Practice Address - Phone:239-313-6300
Practice Address - Fax:239-689-5524
Is Sole Proprietor?:No
Enumeration Date:2010-01-29
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9292622163W00000X
FL11007909363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse