Provider Demographics
NPI:1457187841
Name:GONZALES, MARISA BETH (DNP, APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:BETH
Last Name:GONZALES
Suffix:
Gender:F
Credentials:DNP, APRN, PMHNP-BC
Other - Prefix:DR
Other - First Name:MARISA
Other - Middle Name:B
Other - Last Name:GONZALES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP
Mailing Address - Street 1:8207 MIRAR PASS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78255-3313
Mailing Address - Country:US
Mailing Address - Phone:850-218-4663
Mailing Address - Fax:
Practice Address - Street 1:8207 MIRAR PASS
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78255-3313
Practice Address - Country:US
Practice Address - Phone:850-218-4663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2024073444363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health