Provider Demographics
NPI:1891021804
Name:GONCALVES, ANDERSON CARLOS (AP, DACM)
Entity Type:Individual
Prefix:
First Name:ANDERSON
Middle Name:CARLOS
Last Name:GONCALVES
Suffix:
Gender:M
Credentials:AP, DACM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10935 SE 177TH PL STE 201
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491-8971
Mailing Address - Country:US
Mailing Address - Phone:321-246-1155
Mailing Address - Fax:352-570-9653
Practice Address - Street 1:10935 SE 177TH PL STE 201
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491-8971
Practice Address - Country:US
Practice Address - Phone:321-246-1155
Practice Address - Fax:352-570-9653
Is Sole Proprietor?:No
Enumeration Date:2009-10-26
Last Update Date:2023-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2745171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist