Provider Demographics
NPI:1497272603
Name:GONZALEZ, HERNAN JOSUE (FNP)
Entity Type:Individual
Prefix:
First Name:HERNAN
Middle Name:JOSUE
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:588 BRANTLEY TERRACE WAY UNIT 205
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-0834
Mailing Address - Country:US
Mailing Address - Phone:407-795-2956
Mailing Address - Fax:
Practice Address - Street 1:16903 LAKESIDE DR STE 4D
Practice Address - Street 2:
Practice Address - City:MONTVERDE
Practice Address - State:FL
Practice Address - Zip Code:34756-3241
Practice Address - Country:US
Practice Address - Phone:407-426-4337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-28
Last Update Date:2023-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9418709363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF0816984OtherAMERICAN CADEMY OF NURSE PRACTITIONERS