Provider Demographics
NPI:1679998884
Name:GONZALEZ, KARLA (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13889 FISH EAGLE DRIVE EAST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32226-5091
Mailing Address - Country:US
Mailing Address - Phone:904-402-1453
Mailing Address - Fax:
Practice Address - Street 1:1007 SHERRYWOOD ST
Practice Address - Street 2:
Practice Address - City:FERN PARK
Practice Address - State:FL
Practice Address - Zip Code:32730-2901
Practice Address - Country:US
Practice Address - Phone:904-402-1453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-25
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL36542255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer