Provider Demographics
NPI:1346633146
Name:GONZALEZ, ANCILLA (APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:ANCILLA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7102 N 11TH LN APT 6
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-3176
Mailing Address - Country:US
Mailing Address - Phone:956-960-7856
Mailing Address - Fax:
Practice Address - Street 1:5300 N MCCOLL RD STE 100
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-3969
Practice Address - Country:US
Practice Address - Phone:956-630-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-18
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX702760363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily