Provider Demographics
NPI:1982773800
Name:GONZALEZ, LILIAN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:LILIAN
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 1:10041 SW 98TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2817
Mailing Address - Country:US
Mailing Address - Phone:305-479-9721
Mailing Address - Fax:605-668-8997
Practice Address - Street 1:6705 SW 57TH AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-3622
Practice Address - Country:US
Practice Address - Phone:305-668-8201
Practice Address - Fax:305-668-8997
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2213652363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCG667YMedicare PIN