Provider Demographics
NPI:1740803725
Name:GONZALEZ, ALANNA (IDC)
Entity Type:Individual
Prefix:
First Name:ALANNA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1453 LINDSEYS CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-8088
Mailing Address - Country:US
Mailing Address - Phone:954-918-2266
Mailing Address - Fax:
Practice Address - Street 1:1453 LINDSEYS CROSSING DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-8088
Practice Address - Country:US
Practice Address - Phone:954-918-2266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-25
Last Update Date:2020-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty CorpsmanGroup - Multi-Specialty