Provider Demographics
NPI:1326811720
Name:GONZALES, JONATHON JACOB
Entity Type:Individual
Prefix:MR
First Name:JONATHON
Middle Name:JACOB
Last Name:GONZALES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 OSCEOLA DR # 108
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-5000
Mailing Address - Country:US
Mailing Address - Phone:833-772-1295
Mailing Address - Fax:561-532-0050
Practice Address - Street 1:900 OSCEOLA DR # 108
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-5000
Practice Address - Country:US
Practice Address - Phone:833-772-1295
Practice Address - Fax:561-532-0050
Is Sole Proprietor?:No
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5217753164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse