Provider Demographics
NPI:1407025992
Name:GONZALEZ, EVELYN IRIS (ARNP,FNP-BC)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:IRIS
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:ARNP,FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9009 CORPORATE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-2367
Mailing Address - Country:US
Mailing Address - Phone:813-890-7834
Mailing Address - Fax:855-668-1774
Practice Address - Street 1:9009 CORPORATE LAKE DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-2367
Practice Address - Country:US
Practice Address - Phone:813-890-7834
Practice Address - Fax:855-668-1774
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9256151363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY00Y1OtherBLUE CROSS BLUE SHIELD
FL000673800Medicaid
FL000673800Medicaid