Provider Demographics
NPI:1164974705
Name:GONZALEZ, FIDEL (MS, RN, ACNPC-AG)
Entity Type:Individual
Prefix:MR
First Name:FIDEL
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MS, RN, ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 N 11TH ST
Mailing Address - Street 2:STE P3950
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1527
Mailing Address - Country:US
Mailing Address - Phone:409-892-0099
Mailing Address - Fax:409-892-1911
Practice Address - Street 1:755 N 11TH ST
Practice Address - Street 2:SUITE P-3950
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1500
Practice Address - Country:US
Practice Address - Phone:409-892-0099
Practice Address - Fax:409-892-1911
Is Sole Proprietor?:No
Enumeration Date:2016-10-31
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132432363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care