Provider Demographics
NPI:1588038574
Name:GONZALEZ, LEAH (ARNP)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 CORPORATE WAY
Mailing Address - Street 2:DOOR D
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025
Mailing Address - Country:US
Mailing Address - Phone:954-276-5663
Mailing Address - Fax:954-276-0301
Practice Address - Street 1:1150 N 35TH AVE
Practice Address - Street 2:SUITE 330
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5424
Practice Address - Country:US
Practice Address - Phone:954-265-4325
Practice Address - Fax:954-981-3872
Is Sole Proprietor?:No
Enumeration Date:2015-11-14
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP9326732363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily