Provider Demographics
NPI:1235261900
Name:GONZALEZ, MANUEL DOMENICK (ARNP)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:DOMENICK
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4278 W LINEBAUGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-5241
Mailing Address - Country:US
Mailing Address - Phone:813-977-0733
Mailing Address - Fax:813-971-2230
Practice Address - Street 1:4278 W LINEBAUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-5241
Practice Address - Country:US
Practice Address - Phone:813-977-0733
Practice Address - Fax:813-971-2230
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2908822363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP 2908822OtherNURSE PRACTITIONER