Provider Demographics
NPI:1962928994
Name:GONZALEZ, MIGUEL ANGEL (APRN)
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:ANGEL
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:APRN
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:13880 SHELL POINT PLAZA
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-3504
Mailing Address - Country:US
Mailing Address - Phone:239-466-1111
Mailing Address - Fax:239-454-2111
Practice Address - Street 1:13880 SHELL POINT PLAZA
Practice Address - Street 2:SUITE 110
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3504
Practice Address - Country:US
Practice Address - Phone:239-466-1111
Practice Address - Fax:239-454-2111
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-22
Last Update Date:2022-05-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN9309813364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022054200Medicaid