Provider Demographics
NPI:1134510142
Name:GONZALEZ, JOSE A (RN)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:A
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3321 NW 23RD CT
Mailing Address - Street 2:
Mailing Address - City:LAUD LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33311-2742
Mailing Address - Country:US
Mailing Address - Phone:786-838-8701
Mailing Address - Fax:
Practice Address - Street 1:3321 NW 23RD CT
Practice Address - Street 2:
Practice Address - City:LAUD LAKES
Practice Address - State:FL
Practice Address - Zip Code:33311-2742
Practice Address - Country:US
Practice Address - Phone:786-838-8701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10381163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse