Provider Demographics
NPI:1619348125
Name:GONZALEZ, MELISSA ANN (DNP, APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:EHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, APRN, FNP-BC
Mailing Address - Street 1:501 SW BRADSHAW CIR
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-5535
Mailing Address - Country:US
Mailing Address - Phone:772-607-3531
Mailing Address - Fax:
Practice Address - Street 1:2402 FRIST BLVD STE 201
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4838
Practice Address - Country:US
Practice Address - Phone:772-460-8838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-09
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9325897363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN9325897OtherSTATE LICENSE