Provider Demographics
NPI:1316224074
Name:GONZALEZ, LISA M (APRN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1205 WHIPPOORWILL LN
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34105-5028
Mailing Address - Country:US
Mailing Address - Phone:239-304-1600
Mailing Address - Fax:239-280-5998
Practice Address - Street 1:1223 WHIPPOORWILL LANE
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34105
Practice Address - Country:US
Practice Address - Phone:239-304-1600
Practice Address - Fax:239-280-5999
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2024-03-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL9270587363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner