Provider Demographics
NPI:1710001599
Name:GONZALEZ, BRENDA JOYCE (ANP-C)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:JOYCE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 MONTGOMERY ST FL 9
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-2923
Mailing Address - Country:US
Mailing Address - Phone:315-435-3295
Mailing Address - Fax:315-435-8242
Practice Address - Street 1:421 MONTGOMERY ST FL 9
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-2923
Practice Address - Country:US
Practice Address - Phone:315-435-3295
Practice Address - Fax:315-435-8242
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF-3000925-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4145865OtherMVP