Provider Demographics
NPI:1568055515
Name:GONZALEZ GUTIERREZ, NAMIVIAN (APRN)
Entity Type:Individual
Prefix:
First Name:NAMIVIAN
Middle Name:
Last Name:GONZALEZ GUTIERREZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1392 ROSE CIR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-5834
Mailing Address - Country:US
Mailing Address - Phone:561-306-3000
Mailing Address - Fax:
Practice Address - Street 1:1217 S MILITARY TRL STE C
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-4600
Practice Address - Country:US
Practice Address - Phone:561-642-6309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-19
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11011727363LF0000X
FLAPRN11011727363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily