Provider Demographics
NPI:1821492851
Name:GONZALES, DARLENE NICKOL (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:DARLENE
Middle Name:NICKOL
Last Name:GONZALES
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8705 ROBBY AVE SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-9007
Mailing Address - Country:US
Mailing Address - Phone:505-270-4255
Mailing Address - Fax:
Practice Address - Street 1:8705 ROBBY AVE SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-9007
Practice Address - Country:US
Practice Address - Phone:505-270-4255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-20
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN-73898163WH0200X, 163W00000X
374U00000X, 376J00000X, 261QP2300X
NM79294207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse