Provider Demographics
NPI:1144522996
Name:GONZALEZ, JESSICA ANNE (FNP-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ANNE
Other - Last Name:PROSSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:571 SAINT JOSEPHS BLVD
Mailing Address - Street 2:FL 2
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3230
Mailing Address - Country:US
Mailing Address - Phone:607-271-2050
Mailing Address - Fax:
Practice Address - Street 1:200 MADISON AVE
Practice Address - Street 2:SUITE 2D
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-3218
Practice Address - Country:US
Practice Address - Phone:607-733-4681
Practice Address - Fax:607-733-1729
Is Sole Proprietor?:No
Enumeration Date:2010-11-30
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF336277-1363LF0000X
NY336277363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03316305Medicaid