Provider Demographics
NPI:1578566063
Name:GONZALEZ, AMANDA W (RN,WHNP,BS)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:W
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:RN,WHNP,BS
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:C
Other - Last Name:TYLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:WHNP
Mailing Address - Street 1:1706 TREASURE HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8911
Mailing Address - Country:US
Mailing Address - Phone:956-365-6000
Mailing Address - Fax:
Practice Address - Street 1:191 EAST PRICE ROAD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78523-9988
Practice Address - Country:US
Practice Address - Phone:956-621-3593
Practice Address - Fax:956-621-3689
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP109736363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82N897OtherBLUE CROSS
TX0415796-01Medicaid
TX0415796-01Medicaid
TX82N897Medicare PIN