Provider Demographics
NPI:1457874711
Name:GONZALEZ, GEORGIA FAE (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:FAE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20312 ROBINSON RD
Mailing Address - Street 2:
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34431-6518
Mailing Address - Country:US
Mailing Address - Phone:352-489-0126
Mailing Address - Fax:352-489-0129
Practice Address - Street 1:20312 ROBINSON RD
Practice Address - Street 2:
Practice Address - City:DUNNELLON
Practice Address - State:FL
Practice Address - Zip Code:34431-6518
Practice Address - Country:US
Practice Address - Phone:352-489-0126
Practice Address - Fax:352-489-0129
Is Sole Proprietor?:No
Enumeration Date:2017-07-19
Last Update Date:2019-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9325056363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily