Provider Demographics
NPI:1336851260
Name:GONZALEZ, ANTONIA DEJESUS (APRN)
Entity Type:Individual
Prefix:
First Name:ANTONIA
Middle Name:DEJESUS
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 BISCAYNE BLVD APT 4006
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132-1534
Mailing Address - Country:US
Mailing Address - Phone:305-502-9315
Mailing Address - Fax:
Practice Address - Street 1:888 BISCAYNE BLVD APT 4006
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33132-1534
Practice Address - Country:US
Practice Address - Phone:305-502-9315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11023267363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology