Provider Demographics
NPI:1275989956
Name:ARCENTALES, GONZALO IGNACIO (FNP-BC)
Entity Type:Individual
Prefix:
First Name:GONZALO
Middle Name:IGNACIO
Last Name:ARCENTALES
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 NW 197TH TER
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-3364
Mailing Address - Country:US
Mailing Address - Phone:954-665-1627
Mailing Address - Fax:
Practice Address - Street 1:945 NW 197TH TER
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-3364
Practice Address - Country:US
Practice Address - Phone:954-665-1627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9258719363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily