Provider Demographics
NPI:1841402831
Name:GONZALEZ, JOHN D (RN, DNP,ACNP-BC,NP-C)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:D
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:RN, DNP,ACNP-BC,NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 S MACARTHUR BLVD
Mailing Address - Street 2:105-119
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4216
Mailing Address - Country:US
Mailing Address - Phone:214-448-5817
Mailing Address - Fax:
Practice Address - Street 1:5201 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7708
Practice Address - Country:US
Practice Address - Phone:214-590-1396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201350013NP363LA2100X
OR201350014NP363LA2200X
TXAP113908363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1841402831Medicaid