Provider Demographics
NPI:1780170407
Name:GONZALEZ, IRIDEL B (ARNP)
Entity type:Individual
Prefix:
First Name:IRIDEL
Middle Name:B
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9310 FONTAINEBLEAU BLVD APT A411
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-4661
Mailing Address - Country:US
Mailing Address - Phone:786-390-1533
Mailing Address - Fax:
Practice Address - Street 1:5458 TOWN CENTER RD STE 20
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1009
Practice Address - Country:US
Practice Address - Phone:561-391-6210
Practice Address - Fax:561-391-2810
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL9456789363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics