Provider Demographics
NPI:1114552817
Name:GONZALEZ, SASHA MIREYA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SASHA
Middle Name:MIREYA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:SASHA
Other - Middle Name:MIREYA
Other - Last Name:MORALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:3001 JACARANDA DR
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-7428
Mailing Address - Country:US
Mailing Address - Phone:956-410-9485
Mailing Address - Fax:
Practice Address - Street 1:125 N NUECES PARK LN
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78552-6232
Practice Address - Country:US
Practice Address - Phone:956-410-9485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-03
Last Update Date:2022-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX875145163WP0200X
TXAP145560363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP0200XNursing Service ProvidersRegistered NursePediatrics