Provider Demographics
NPI:1295984573
Name:GONZALEZ, LORY EMILY (ARNP,CDE)
Entity type:Individual
Prefix:MRS
First Name:LORY
Middle Name:EMILY
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:ARNP,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 NW 10TH AVE
Mailing Address - Street 2:SUITE# 1006
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1011
Mailing Address - Country:US
Mailing Address - Phone:305-243-3498
Mailing Address - Fax:
Practice Address - Street 1:1450 NW 10TH AVE
Practice Address - Street 2:SUITE# 1006
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1011
Practice Address - Country:US
Practice Address - Phone:305-243-3498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-11
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2951282363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health