Provider Demographics
NPI:1659697878
Name:GONZALES, CHARMAINE JACKQULIN (ANP)
Entity Type:Individual
Prefix:
First Name:CHARMAINE
Middle Name:JACKQULIN
Last Name:GONZALES
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:CHARMAINE
Other - Middle Name:JACKQULIN
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 PENN PLZ
Mailing Address - Street 2:7TH FLOOR, SUITE 725
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10119-0002
Mailing Address - Country:US
Mailing Address - Phone:888-315-5442
Mailing Address - Fax:212-809-7355
Practice Address - Street 1:1 PENN PLZ
Practice Address - Street 2:7TH FLOOR, SUITE 725
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10119-0002
Practice Address - Country:US
Practice Address - Phone:888-315-5442
Practice Address - Fax:212-809-7355
Is Sole Proprietor?:No
Enumeration Date:2010-04-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF305324-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health