Provider Demographics
NPI:1487031225
Name:GONZALEZ, LORRAINE LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:LYNN
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7903 ISAAC PRYOR DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-1751
Mailing Address - Country:US
Mailing Address - Phone:512-215-6648
Mailing Address - Fax:
Practice Address - Street 1:14100 RANCH ROAD 12
Practice Address - Street 2:SUITE 900
Practice Address - City:WIMBERLEY
Practice Address - State:TX
Practice Address - Zip Code:78676-5354
Practice Address - Country:US
Practice Address - Phone:512-847-0300
Practice Address - Fax:512-847-0200
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-30
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03401363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant