Provider Demographics
NPI:1639822752
Name:GONZALO, DEONNA MARIE (MSN, APRN, AGNP)
Entity Type:Individual
Prefix:
First Name:DEONNA
Middle Name:MARIE
Last Name:GONZALO
Suffix:
Gender:F
Credentials:MSN, APRN, AGNP
Other - Prefix:
Other - First Name:DEONNA
Other - Middle Name:MARIE
Other - Last Name:D'ALTORIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 917770
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6833 MEDICAL VIEW LN
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-6614
Practice Address - Country:US
Practice Address - Phone:813-780-6677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-28
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11017809363LF0000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily