Provider Demographics
NPI:1376297713
Name:DRG MEDICAL CENTER, LLC
Entity type:Organization
Organization Name:DRG MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOALEXIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP-C
Authorized Official - Phone:321-402-7829
Mailing Address - Street 1:1960 N JOHN YOUNG PKWY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-3221
Mailing Address - Country:US
Mailing Address - Phone:321-402-7829
Mailing Address - Fax:855-540-1852
Practice Address - Street 1:1960 N JOHN YOUNG PKWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-3221
Practice Address - Country:US
Practice Address - Phone:321-402-7829
Practice Address - Fax:855-540-1852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-04
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty