Provider Demographics
NPI:1437868700
Name:AFON GONZALEZ, LIEN
Entity Type:Individual
Prefix:
First Name:LIEN
Middle Name:
Last Name:AFON GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13911 N DALE MABRY HWY STE 108
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2414
Mailing Address - Country:US
Mailing Address - Phone:813-964-6395
Mailing Address - Fax:813-964-6551
Practice Address - Street 1:13911 N DALE MABRY HWY STE 108
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2414
Practice Address - Country:US
Practice Address - Phone:813-964-6395
Practice Address - Fax:813-964-6551
Is Sole Proprietor?:No
Enumeration Date:2022-11-15
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11023029363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily