Provider Demographics
NPI:1073295440
Name:FERNANDEZ GONGORA, LILIA A (MSN, APRN, AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:LILIA
Middle Name:A
Last Name:FERNANDEZ GONGORA
Suffix:
Gender:F
Credentials:MSN, APRN, AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7463 NW 178TH TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-8434
Mailing Address - Country:US
Mailing Address - Phone:305-316-9263
Mailing Address - Fax:
Practice Address - Street 1:7463 NW 178TH TER
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-8434
Practice Address - Country:US
Practice Address - Phone:305-316-9263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11027790363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology