Provider Demographics
NPI:1538639489
Name:GONZALEZ, NICOLE KRYSTAL (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:KRYSTAL
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5536 KOOL SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-9527
Mailing Address - Country:US
Mailing Address - Phone:559-786-0127
Mailing Address - Fax:
Practice Address - Street 1:10826 MALLARD CREEK RD STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-7785
Practice Address - Country:US
Practice Address - Phone:704-774-3044
Practice Address - Fax:704-774-3045
Is Sole Proprietor?:No
Enumeration Date:2018-12-03
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF06180248363LF0000X
NC5016697363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily