Provider Demographics
NPI:1598337172
Name:GONZALEZ, LETICIA FLOURNOY (FNP)
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:FLOURNOY
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 WINDY KNOLL RD
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-2786
Mailing Address - Country:US
Mailing Address - Phone:817-995-4203
Mailing Address - Fax:
Practice Address - Street 1:1650 S BEACH ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76105-2209
Practice Address - Country:US
Practice Address - Phone:817-702-1100
Practice Address - Fax:817-702-6124
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1047237363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily