Provider Demographics
NPI:1356736052
Name:GONZALEZ, ANGEL ROBERTO (FNP)
Entity type:Individual
Prefix:MR
First Name:ANGEL
Middle Name:ROBERTO
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:MR
Other - First Name:ANGEL
Other - Middle Name:ROBERTO
Other - Last Name:PINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7704 HILLOCK TER
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78744-1519
Mailing Address - Country:US
Mailing Address - Phone:915-240-5308
Mailing Address - Fax:
Practice Address - Street 1:844 KOHLERS XING STE 230
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-2475
Practice Address - Country:US
Practice Address - Phone:737-404-3926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-31
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171W00000X
TXAP127937363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No171W00000XOther Service ProvidersContractor