Provider Demographics
NPI:1073589214
Name:GONZALES, KATHIE ANN (ARNP-BC)
Entity Type:Individual
Prefix:
First Name:KATHIE
Middle Name:ANN
Last Name:GONZALES
Suffix:
Gender:F
Credentials:ARNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24945 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33763-3927
Mailing Address - Country:US
Mailing Address - Phone:727-726-1460
Mailing Address - Fax:727-724-9705
Practice Address - Street 1:24945 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-3927
Practice Address - Country:US
Practice Address - Phone:727-726-1460
Practice Address - Fax:727-724-9705
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3383662363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY087MOtherBCBSF
FL3073238 00Medicaid
FL3073238 00Medicaid