Provider Demographics
NPI:1407575483
Name:GONZALES, COURTNEY B (RN)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:B
Last Name:GONZALES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4903 MIDTOWN LN
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-3403
Mailing Address - Country:US
Mailing Address - Phone:561-693-0170
Mailing Address - Fax:
Practice Address - Street 1:448 GOLD XING
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-6352
Practice Address - Country:US
Practice Address - Phone:806-441-2491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN299323163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse