Provider Demographics
NPI:1942243860
Name:GONZALES, GLORIA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:GONZALES
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 DEMOCRACY DR STE 150
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-4202
Mailing Address - Country:US
Mailing Address - Phone:972-494-3100
Mailing Address - Fax:972-608-0005
Practice Address - Street 1:5425 W SPRING CREEK PKWY STE 140
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-4318
Practice Address - Country:US
Practice Address - Phone:972-494-3100
Practice Address - Fax:972-608-0005
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX588973363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161174101Medicaid
OK1611741031OtherTPI 1611741031
OK200223360AMedicaid
TX161174101Medicaid