Provider Demographics
NPI:1639951254
Name:GONZALEZ, YASMIN DIANARIS
Entity Type:Individual
Prefix:
First Name:YASMIN
Middle Name:DIANARIS
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 THISTLEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-3348
Mailing Address - Country:US
Mailing Address - Phone:407-371-7022
Mailing Address - Fax:
Practice Address - Street 1:210 THISTLEWOOD CIR
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-3348
Practice Address - Country:US
Practice Address - Phone:407-371-7022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11029116363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily