Provider Demographics
NPI:1811572027
Name:GONZALEZ, JENNA KAREE (NP)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:KAREE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10443 TAM O SHANTER RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-8306
Mailing Address - Country:US
Mailing Address - Phone:850-503-0480
Mailing Address - Fax:
Practice Address - Street 1:10443 TAM O SHANTER RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-8306
Practice Address - Country:US
Practice Address - Phone:850-503-0480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11011927363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner