Provider Demographics
NPI:1811171531
Name:GONZALEZ, GINNA (ARNP)
Entity type:Individual
Prefix:
First Name:GINNA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 NW 14TH ST
Mailing Address - Street 2:1311
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-2107
Mailing Address - Country:US
Mailing Address - Phone:305-243-6837
Mailing Address - Fax:305-243-8470
Practice Address - Street 1:1150 NW 14TH ST
Practice Address - Street 2:407
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-2137
Practice Address - Country:US
Practice Address - Phone:305-243-6837
Practice Address - Fax:305-243-8470
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1800082363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAI420Medicare PIN
FLAI420YMedicare PIN