Provider Demographics
NPI:1811010945
Name:GONZALEZ, ROSALINDA (ARNP)
Entity Type:Individual
Prefix:MS
First Name:ROSALINDA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 PRATT BLVD
Mailing Address - Street 2:
Mailing Address - City:LABELLE
Mailing Address - State:FL
Mailing Address - Zip Code:33935-4405
Mailing Address - Country:US
Mailing Address - Phone:863-674-4041
Mailing Address - Fax:863-674-4604
Practice Address - Street 1:1140 PRATT BLVD
Practice Address - Street 2:
Practice Address - City:LABELLE
Practice Address - State:FL
Practice Address - Zip Code:33935-4405
Practice Address - Country:US
Practice Address - Phone:863-674-4041
Practice Address - Fax:863-674-4604
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 678642363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY004ZOtherBLUECROSS BLUE SHIELD
FL3024482-00Medicaid