Provider Demographics
NPI:1609524859
Name:GONZALEZ, JOVANNY ROLANDO (RN)
Entity Type:Individual
Prefix:
First Name:JOVANNY
Middle Name:ROLANDO
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 NW 151ST ST STE 112
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2428
Mailing Address - Country:US
Mailing Address - Phone:954-249-8097
Mailing Address - Fax:305-643-3972
Practice Address - Street 1:5901 NW 151ST ST STE 112
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2428
Practice Address - Country:US
Practice Address - Phone:954-249-8097
Practice Address - Fax:305-643-3972
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9448496163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse