Provider Demographics
NPI:1568859551
Name:GONZALEZ, JOSE T JR (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:T
Last Name:GONZALEZ
Suffix:JR
Gender:M
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 1:711 STUDIO LN
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78542-5785
Mailing Address - Country:US
Mailing Address - Phone:956-393-9521
Mailing Address - Fax:
Practice Address - Street 1:334 LINDBERG AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-2943
Practice Address - Country:US
Practice Address - Phone:956-686-2020
Practice Address - Fax:956-686-3094
Is Sole Proprietor?:No
Enumeration Date:2015-04-17
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128028363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3456667-01Medicaid
TX410251YKSJMedicare PIN