Provider Demographics
NPI:1639455330
Name:GONZALEZ, JACQUELINE (APN)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 KUENZLI ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-0845
Mailing Address - Country:US
Mailing Address - Phone:775-982-5966
Mailing Address - Fax:775-982-5496
Practice Address - Street 1:202 LOS ALTOS PKWY
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-7708
Practice Address - Country:US
Practice Address - Phone:775-982-5000
Practice Address - Fax:775-982-3900
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN001338363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily