Provider Demographics
NPI:1629584289
Name:AYES-GONZALEZ, JOELY (GNP-C)
Entity Type:Individual
Prefix:DR
First Name:JOELY
Middle Name:
Last Name:AYES-GONZALEZ
Suffix:
Gender:F
Credentials:GNP-C
Other - Prefix:
Other - First Name:JOELY
Other - Middle Name:
Other - Last Name:AYES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, ARNP
Mailing Address - Street 1:375 SW LAKE FOREST WAY
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2071
Mailing Address - Country:US
Mailing Address - Phone:502-528-4709
Mailing Address - Fax:
Practice Address - Street 1:5000 DUNN RD FL 34981
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34981-4901
Practice Address - Country:US
Practice Address - Phone:502-528-4709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9409894363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherN/A