Provider Demographics
NPI:1326621384
Name:GONZALEZ, TEIA K (LPN)
Entity Type:Individual
Prefix:
First Name:TEIA
Middle Name:K
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13927 HERITAGE CLUB DR # 606
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-2033
Mailing Address - Country:US
Mailing Address - Phone:813-446-2731
Mailing Address - Fax:
Practice Address - Street 1:13927 HERITAGE CLUB DR # 606
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-2033
Practice Address - Country:US
Practice Address - Phone:813-446-2731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5241647164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse